PMC10080205_01
Esophagogastroduodenoscopy shows several fibrin-covered erosions in the duodenum that are indicative of duodenitis.
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F1
A diagnostic esophagogastroduodenoscopy revealed multiple fibrin covered erosions indicative of duodenitis (shown in Fig. 1).
a Left: Duodenal biopsy reveals complete villous atrophy (H&E stain, x20 magnification). a Right: Duodenal biopsy shows intraepithelial leukocytosis (H&E stain, x200 magnification). b Normal duodenal mucosa with villi and microvilli (H&E stain, x40 magnification).
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F2
Histological analysis of samples taken in the duodenum showed signs of a noninfectious inflammation with complete villous atrophy, as shown in Figure 2a as compared to a specimen from a non-affected person in Figure 2b.
Ileocolonoscopy shows diverticula without signs of inflammation.
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F3
Ileocolonoscopy was macroscopically unremarkable apart from diverticula without signs of inflammation (shown in Fig. 3).
Colonic biopsy shows intraepithelial leukocytosis and proliferation of collagenous connective tissue forming subepithelial collagen bands without signs of ischemia (H&E stain, x200 magnification).
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F4
Colonic biopsies were consistent with a mild chronic mucosal inflammation: intraepithelial leukocytosis and proliferation of collagenous connective tissue forming subepithelial collagen bands (shown in Fig. 4).
Duodenal immunohistochemistry shows intraepithelial CD3-positive T-lymphocytic infiltration (DAB staining with hematoxylin nuclear counterstaining, x40 magnification).
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F5
Immunohistochemistry showed significant intraepithelial CD3-positive T-lymphocytic infiltration in the duodenum (shown in Fig. 5).
a Colonic immunohistochemistry shows intraepithelial CD3-positive T-lymphocytic infiltration (DAB staining with hematoxylin nuclear counterstaining, x100 magnification). b Colonic immunohistochemistry shows subepithelial collagen bands in blue (Ladewig's staining, x200 magnification).
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F6
Fig. 6a, b, respectively), but the diagnostic threshold for lymphocytic colitis (20 intraepithelial lymphocytes [IELs]/100 enterocytes) and/or collagenous colitis (subepithelial band thickness of >10micro) was not met. Furthermore, the increase in IELs did not meet the diagnostic threshold of 40 IELs/100 enterocytes for celiac disease using the MARSH classification.