PMC7550934_01
Endoscopy (upper images) and corresponding histology findings (lower image)
in the distal sigmoid area during the course of the cyclosporin/ustekinumab
therapy. (A) Before initiation of cyclosporin therapy, there are multiple
superficial mucosal ulcers and spontaneous bleeding as signs of severe
endoscopic disease. (B) Histology findings indicate signs of severe acute
and chronic inflammation with architectural disorders, surface erosions and
ulcerations. (C) At 8 weeks after initiating combination therapy with
cyclosporin and ustekinumab, there is mucosal erythema and decreased
vascular pattern as signs of mild endoscopic inflammation. (D) Histology
demonstrates changes compatible with moderate inflammation. The surface
appears intact, and there is moderate chronic and less acute cell
infiltration with neutrophils and some eosinophils, granulocytic cells as
well as plasmocytic infiltration and less mucin depletion. Furthermore, mild
architectural disorder with interstitial, sometimes scar-like, fibrosis. (E)
Under ongoing ustekinumab maintenance monotherapy, there is endoscopic
remission with normal mucosal appearance. (F) Histology indicates mild
mucosal inflammation with an intact surface, moderate chronic and just few
signs of acute inflammation with regressive infiltration of neutrophils and
just few eosinophilic granulocytes, as well as few plasmocytic cells and no
mucin depletion. Mild architectural disorder with interstitial, sometimes
scar-like, fibrosis. Histological images (20x) were taken using a Leica DM
4000 B microscope (Leica Microsystems, Wetzlar, Germany) with Jenoptik
Progres Gryphax SUBRA camera (Jenoptik, Jena, Germany).
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Upon admission, sigmoidoscopy showed signs of severe endoscopic inflammation (endoscopic Mayo score: 3) with spontaneous bleeding and extended superficial mucosal ulcerations (Figure 1A) and histology confirmed severe inflammation (Geboes score: 5) (Figure 1B). Endoscopy demonstrated signs of only mild mucosal disease (endoscopic Mayo score: 1) with mucosal erythema and decreased vascular pattern (Figure 1C), while histology also confirmed mild inflammation (Geboes score: 3) (Figure 1D). Sigmoidoscopy demonstrated endoscopic remission (endoscopic Mayo score: 0) without signs of active inflammation (Figure 1E) and histology just showed signs of mild inflammatory activity (Geboes score: 2) (Figure 1F).