case_images: PMC10080205_01
case_images: Esophagogastroduodenoscopy shows several fibrin-covered erosions in the duodenum that are indicative of duodenitis.
case_images: crg529003_f01.jpg
case_images: PMC10080205_01_crg529003_f01.jpg
case_images: F1
case_images: A diagnostic esophagogastroduodenoscopy revealed multiple fibrin covered erosions indicative of duodenitis (shown in Fig. 1).
case_images: 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).
case_images: crg529003_f02.jpg
case_images: PMC10080205_01_crg529003_f02.jpg
case_images: F2
case_images: 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.
case_images: Ileocolonoscopy shows diverticula without signs of inflammation.
case_images: crg529003_f03.jpg
case_images: PMC10080205_01_crg529003_f03.jpg
case_images: F3
case_images: Ileocolonoscopy was macroscopically unremarkable apart from diverticula without signs of inflammation (shown in Fig. 3).
case_images: Colonic biopsy shows intraepithelial leukocytosis and proliferation of collagenous connective tissue forming subepithelial collagen bands without signs of ischemia (H&E stain, x200 magnification).
case_images: crg529003_f04.jpg
case_images: PMC10080205_01_crg529003_f04.jpg
case_images: F4
case_images: 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).
case_images: Duodenal immunohistochemistry shows intraepithelial CD3-positive T-lymphocytic infiltration (DAB staining with hematoxylin nuclear counterstaining, x40 magnification).
case_images: crg529003_f05.jpg
case_images: PMC10080205_01_crg529003_f05.jpg
case_images: F5
case_images: Immunohistochemistry showed significant intraepithelial CD3-positive T-lymphocytic infiltration in the duodenum (shown in Fig. 5).
case_images: 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).
case_images: crg529003_f06.jpg
case_images: PMC10080205_01_crg529003_f06.jpg
case_images: F6
case_images: 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.