Spot diagnosis

Hint: This moiré pattern lines the colon and the patient is a woman

A 50-year-old woman is referred to the gastroenterology clinic for a routine colonoscopy.

She mentions she is often tired, but is otherwise well. On examination, she is 165cm tall, weighs 63kg and has conjunctival pallor.

Colonoscopy reveals dark-brown to black discoloration in a moiré pattern lining the large intestine.

A biopsy of the large intestine is sent for analysis. Based on these findings, a history of which of the following is most likely?

  • Crohn’s disease
  • Bulimia nervosa
  • Peutz-Jeghers syndrome
  • Cigarette smoking

Answer: Bulimia nervosa