Fish scale crystals: an under-recognised cause of intestinal necrosis

Abstract

A middle-aged patient with chronic obstructive pulmonary disease (COPD) gold III was admitted to the intensive care unit with an acute, severe exacerbation of COPD. Six days after admission, the patient developed acute kidney injury with hyperkalaemia, for which the patient was treated. Kidney function further deteriorated and after 3\u2009days, continuous venovenous haemofiltration was started. Several days later, a paralytic ileus developed. Subsequently, the patient underwent an exploratory laparotomy, which revealed fibrinous deposits and oedematous, poorly perfused and ischaemic small intestines with two perforations. The resection specimen was submitted for histopathological examination.\n\nReview the high-quality, interactive digital Aperio slide at\xa0http://virtualacp.com/JCPCases/jclinpath-2018-205203/ and consider your diagnosis.\n\n1. Cholestyramine-induced ischaemia.\n\n2. Idiopathic ischaemia.\n\n3. Ischaemic enteritis due to vasculitis.\n\n4. Sevelamer-induced …