case_images: PMC7204888_01
case_images: Oropharyngeal thrush.
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case_images: F1
case_images: Oral cavity examination was consistent with severe oropharyngeal candidiasis (Fig. 1).
case_images: Nasopharyngoscopy showed patch of thrush on the anterior nasal septum.
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case_images: F2
case_images: He underwent nasopharyngoscopy which confirmed tongue findings as of OGD but also found patch of thrush on the anterior nasal septum (Fig. 2).
case_images: CT of the abdomen with contrast revealing terminal ilium and ileo-cecal valve thickening (arrow), mucosal hyperenhancement, and vascular engorgement.
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case_images: F3
case_images: 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).
case_images: Upper GI endoscopy showing a heavily white coated tongue which could not be easily scrapped off by endoscope.
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case_images: F4
case_images: OGD showed white heavily coated tongue which could not be easily scrapped off by endoscope (Fig. 4).
case_images: Colonoscopy showing friable mucosa of terminal ileum and IC (ileo-cecal) valve with some ulcers.
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case_images: F5
case_images: Colonoscopy findings were multiple deep ulcers with erythematous and friable mucosa of terminal ileum and diseased IC valve with some ulcers (Fig. 5).
case_images: Colonoscopy showing descending colon with multiple tiny aphthous ulcers at the recto-sigmoid junction.
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case_images: F6
case_images: However, the descending colon showed multiple tiny aphthous ulcers at the recto-sigmoid junction (Fig. 6).
case_images: 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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case_images: F7
case_images: Biopsy from the ilium and IC valve suggested moderate to severe chronic active inflammation with granulation tissue (Fig. 7).
case_images: 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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case_images: F8
case_images: OPD which showed active disease (Fig. 8). On his second outpatient visit, prednisolone 40 mg was also added.