PMC7204888_01
Oropharyngeal thrush.
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F1
Oral cavity examination was consistent with severe oropharyngeal candidiasis (Fig. 1).
Nasopharyngoscopy showed patch of thrush on the anterior nasal septum.
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F2
He underwent nasopharyngoscopy which confirmed tongue findings as of OGD but also found patch of thrush on the anterior nasal septum (Fig. 2).
CT of the abdomen with contrast revealing terminal ilium and ileo-cecal valve thickening (arrow), mucosal hyperenhancement, and vascular engorgement.
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F3
CT scan showed terminal ilium and ilio-cecal (IC) valve thickening, mucosal hyperenhancement, vascular engorgement, and surrounding fat stranding with adjacent subcentimetric lymph nodes (Fig. 3).
Upper GI endoscopy showing a heavily white coated tongue which could not be easily scrapped off by endoscope.
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F4
OGD showed white heavily coated tongue which could not be easily scrapped off by endoscope (Fig. 4).
Colonoscopy showing friable mucosa of terminal ileum and IC (ileo-cecal) valve with some ulcers.
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F5
Colonoscopy findings were multiple deep ulcers with erythematous and friable mucosa of terminal ileum and diseased IC valve with some ulcers (Fig. 5).
Colonoscopy showing descending colon with multiple tiny aphthous ulcers at the recto-sigmoid junction.
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F6
However, the descending colon showed multiple tiny aphthous ulcers at the recto-sigmoid junction (Fig. 6).
Histopathology photograph depicting colonic mucosa with chronic changes in the form of crypts architectural distortion. The glands show irregularity and branching (hematoxylin and eosin stain 1,000).
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F7
Biopsy from the ilium and IC valve suggested moderate to severe chronic active inflammation with granulation tissue (Fig. 7).
MRI enteroclysis: the distal ileum, ileo-cecal junction, and cecal pole demonstrate mucosal thickening. Post contrast early enhancement and diffusion restriction is most prominently at the ileo-cecal junction. The distal ileal loop demonstrates engorgement of its mesenteric vessels representing comb sign.
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F8
OPD which showed active disease (Fig. 8). On his second outpatient visit, prednisolone 40 mg was also added.