Mucosal islands in ulcerative colitis: A simple clue of severity on an abdominal radiograph

Ulcerative colitis is usually localised to the colon, leading to a uniform mucosal inflammation. Rarely, endoscopic findings or even an abdominal radiograph may reveal mucosal islands, which are defined as patches of residual normal mucosa within inflamed areas. They usually portend a poor prognosis. We report such a case where cytomegalovirus colitis, confirmed via immuno-histochemistry, was found. This case highlights the potential prognostic value of these findings, which, though subtle, can guide early, aggressive, but effective management.