PMC8864130_01
Ileocolonoscopy and MRI conducted at diagnosis of Crohn's disease. (A) Ileocolonoscopy revealed an ulcer in the terminal ileum, and (B) linear deep ulcers with cobblestoning in the transverse colon. (C) MRE shows multifocal asymmetric bowel wall thickening involving the transverse colon, terminal ileum, and jejunum and luminal narrowing in the transverse colon with diffusion restriction and enhancement. (D) MRI of the pelvis shows two intersphincteric perianal fistulas. MRI, magnetic resonance imaging; MRE, magnetic resonance enterography.
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F1
Ileocolonoscopy showed multifocal ulcers throughout the terminal ileum and colon (Figures 1A,B). Magnetic resonance enterography showed multifocal wall thickening in the colon, ileum, and jejunum and two intersphincteric perianal fistulas (Figures 1C,D).
Chest CT conducted (A) at diagnosis of miliary TB and (B) after TB treatment. (A) Innumerable small discrete nodules of random distribution with tree in bud pattern are observed in both lungs. (B) There is a decrease in extent of the innumerable small nodules in both lungs. CT, computed tomography; TB, tuberculosis.
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F2
Chest x-ray and chest computed tomography (CT) showed multiple small nodules in both lungs indicating miliary TB (Figure 2A). Miliary TB was completely cured after 6 months of TB treatment (Figure 2B).
Abdomen CT conducted at 3 months after cessation of miliary TB treatment. A newly defined presumed cold abscess within the left psoas muscle at the level of T10 to L2 and TB spondylitis at the T12 and L1 are observed. CT, computed tomography; TB, tuberculosis.
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F3
No active CD involvement was observed in the bowel, whereas a newly developed left psoas muscle abscess and spinal bony destruction were incidentally identified (Figure 3).
Spinal MRI conducted (A) at diagnosis of spinal TB and (B,C) follow-up images. (A) Bone marrow enhancement at T11-12-L1 with paraspinal fluid collection at left anterolateral side, and relatively thin wall enhancement. (B) Improvement is noted at 1-year follow-up after TB treatment initiation. (C) Imaging conducted 1 year after VDZ initiation shows no reactivation of the TB spondylitis. MRI, magnetic resonance imaging; TB, tuberculosis; VDZ, vedolizumab.
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F4
Spinal MRI was conducted to confirm the diagnosis of TB spondylitis (Figure 4A). Spinal magnetic resonance imaging (MRI) at 1-year follow-up after TB treatment revealed that her spinal lesions were cured (Figure 4B). Spinal MRI conducted 1 year after VDZ initiation showed no reactivation of her TB spondylitis (Figure 4C).