Sushrut Ingawale, Rahul Kothari, Pujitha Vallivedu, Shivaji Karki, Gagandeep Singh Talwar, Jack Jacob, David Regelmann, Prabin Sharma
The colon single stripe sign (CSSS) is associated with ischemic-pattern colonic injury. We report a 69-year-old woman with norovirus infection, hematochezia, recurrent left-sided colitis, and chronic NSAID use found to have CSSS on colonoscopy, suggesting a multifactorial "two-hit" mechanism involving NSAID-related mucosal vulnerability and transient hypoperfusion.