PMC10060632_01
Colonoscopic images showing erythema and granularity of the examined colon mucosa with superficial exudated ulcerations, loss of normal vascular pattern and areas of spontaneous bleeding (Mayo Endoscopy Subscore 3).
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There was a loss of haustrations and loss of normal vascular pattern with areas of spontaneous bleeding - Mayo Endoscopy Subscore 3 (Figure 1).
Histopathology images of endoscopic colon biopsy showing colonic mucosa with an inflammatory expansion of the lamina propria (A, H&E 40x), acute cryptitis (B, H&E 100X), and crypt abscesses (C, H&E 200X).
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On histopathology, colonic mucosa had relatively preserved architecture showing a marked expansion of the lamina propria by lymphoplasmacytic infiltrate (basal plasmocytosis) and mucosal neutrophilic infiltration with cryptitis and crypt abscesses (Figure 2).
MRI images of the upper abdomen depicting pre-contrast bulky pancreas (A) and post-contrast delayed diffuse homogenous enhancement of the pancreas (B) consistent with autoimmune pancreatitis.
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Magnetic resonance cholangiopancreatography (MRCP) and contrast-enhanced MRI of the abdomen performed 10 days after initial presentation revealed a diffusely-enlarged, bulky pancreas showing delayed diffuse homogenous enhancement with no clear evidence of foci of necrosis or abscess formation (Figures 3A,B).
Change of liver enzymes over time.
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Liver enzyme follow-up before and after commencing steroids is depicted in Figure 4, with rapid normalization of enzymes following steroid treatment.