title: Leopard Skin-Like Colonic Mucosa: A Novel Endoscopic Finding of Chronic Granulomatous Disease-Associated Colitis.
abstract: BACKGROUND
  Chronic granulomatous disease (CGD) is a rare inherited disorder in which phagocytes are unable to eradicate pathogens because of a deficit of nicotinamide adenine dinucleotide phosphate oxidase. Among CGD patients, ∼ 30% to 50% develop severe gastrointestinal tract symptoms. Although characteristic histologic findings of CGD-associated colitis have been reported, information on endoscopic features remained vague.
  
  
  METHODS
  A total of 8 male patients with CGD (ages 2-23 years) from 2 Japanese institutions underwent colonoscopy for the evaluation of their fever, diarrhea, bloody stool, and abdominal pain. The endoscopic and histologic findings were retrospectively reviewed.
  
  
  RESULTS
  The endoscopic findings of CGD-associated colitis appeared varied. Notably, brownish dots over a yellowish edematous mucosa were observed in 3 of the 8 patients. Prominent pigment-laden macrophages were noted histologically on the mucosa.
  
  
  CONCLUSIONS
  Although nonspecific endoscopic findings of CGD-associated colitis have been reported before, our observation of brownish dots spread across a yellowish edematous mucosa, termed "leopard sign," could be a unique feature of this condition.
authors.affiliation: *Division of Gastroenterology †Department of Pathology, National Center for Child Health and Development, Tokyo ‡Division of Pediatrics, Department of Reproductive and Developmental Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki §Division of Immunology, National Center for Child Health and Development, Tokyo ||Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki ¶Department of Pediatric and Adolescent Medicine, Juntendo University Graduate School of Medicine #Department of Education for Clinical Research, National Center for Child Health and Development, Tokyo **Department of Pediatrics, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan.
authors.forename: Naho
authors.initials: N
authors.lastname: Obayashi
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Arai
authors.forename: Natsuko
authors.initials: N
authors.lastname: Nakano
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Mizukami
authors.forename: Toshinao
authors.initials: T
authors.lastname: Kawai
authors.forename: Shojiro
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Shimizu
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nunoi
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shimizu
authors.forename: Julian
authors.initials: J
authors.lastname: Tang
authors.forename: Masafumi
authors.initials: M
authors.lastname: Onodera
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000473:pathology; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000473:pathology*; D003113:Colonoscopy; D003424:Crohn Disease / Q000150:complications / Q000473:pathology* / Q000601:surgery; D003967:Diarrhea / Q000209:etiology / Q000473:pathology; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000473:pathology; D006105:Granulomatous Disease, Chronic / Q000150:complications / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008264:Macrophages / Q000473:pathology; D008297:Male; D010858:Pigmentation; D012189:Retrospective Studies; D055815:Young Adult