PMC6358579_01
Endoscopic picture from colonoscopy in 2016 revealing diffusely edematous mucosa.
CG-CGCR180082F001.jpg
PMC6358579_01_CG-CGCR180082F001.jpg
F1
Colonoscopy was significant for a loss of the normal vascular pattern throughout the colon (Figure 1).
The patient's 2015 biopsy revealed (A) villous blunting, increased lamina propria lymphoplasmacytic infiltrate, increased epithelial lymphocytes in the duodenum, and absence of goblet cells; and (B) increased lamina propria lymphoplasmacytic infiltrate and an absence of goblet cells in the colon. Patchy neutrophilic cryptitis and a marked increase in intraepithelial crypt apoptosis are also seen.
CG-CGCR180082F002.jpg
PMC6358579_01_CG-CGCR180082F002.jpg
F2
Duodenal and colonic biopsies were negative for malignancy but did reveal villous blunting, chronic inflammation of the lamina propria, intraepithelial lymphocytes, and decreased goblet cells (Figure 2).
Endoscopic picture taken from the patient's most recent colonoscopy depicting a less inflamed but still edematous mucosa.
CG-CGCR180082F003.jpg
PMC6358579_01_CG-CGCR180082F003.jpg
F3
Repeat colonoscopy revealed reduced inflammation and only mild congestion, although there was still histological evidence of villous blunting, increased intraepithelial lymphocytes, and decreased goblet cells (Figure 3, Figure 4).
(A) Recent biopsy of the duodenum showing findings similar to those of previous biopsies, though with some improvement in the degree of inflammation and the amount of lymphoplasmacytic lamina propria inflammation. Note the more intact villous architecture of the duodenum. (B) Recent biopsy of the colon showing findings similar to prior biopsies with improvement in the amount of lymphoplasmacytic lamina propria inflammation and neutrophilic cryptitis. Increased crypt epithelial apoptoses are still present. A paucity of goblet cells remains, but they are increased in number compared to previous biopsies.
CG-CGCR180082F004.jpg
PMC6358579_01_CG-CGCR180082F004.jpg
F4
Repeat colonoscopy revealed reduced inflammation and only mild congestion, although there was still histological evidence of villous blunting, increased intraepithelial lymphocytes, and decreased goblet cells (Figure 3, Figure 4).