PMC6900620_01
Endoscopy of the terminal ileum. (a) The black arrows show multiple ulcers
with regular borders on edematous mucosa seen in the terminal ileum of the
patient. (b) The blue arrows show edematous erythematous mucosa with
nodularity in patient's terminal ileum. (c) Endoscopy of healthy terminal
ileum from another patient being shown for comparison.
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The patient underwent an elective colonoscopy for colorectal cancer screening in February 2019, which revealed inflammation and multiple ulcers in the terminal ileum, suggestive of CD with a normal-appearing colon (Figure 1).
Histopthology of the ileal mucosa biopsy. (a) Histopathology of the ileal
mucosa demonstrates there is preservation of the crypt architecture with the
presence of mucin depletion and reactive epithelial changes. The lamina
propria contains increased numbers of inflammatory cells (lymphocytes and
plasma cells) as shown by the blue arrows. (b) On higher magnification,
neutrophils are seen superficially with superficial cryptitis (neutrophils
infiltrating the crypt epithelium) without crypt abscesses and active
inflammation as shown by the black arrows.
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Terminal ileum biopsies revealed chronic active ileitis, which is seen in CD; however, there were no granulomas, no crypt abscesses and no evidence of dysplasia or malignancy (Figure 2).