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case_images: The endoscopy image in all stages of the treatment. (A) The colonoscopy before colectomy. The colonoscopy showed the mucosa was diffusely congested, with edema. Shallow ulcers were formed, and covered with white patches. The colonic bag disappeared, and the vein texture was unclear. (B) The ileoscopy after colectomy. The ileoscopy showed a disappearance of intestinal villi and an irregular vascular network. (C) The ileoscopy after treatment with ustekinumab.The ileoscopy showed intestinal villi was normal.
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case_images: Under this circumstance, a colonoscopy was performed, revealing mucosal edema, congestion and erosion, accompanied by flake-like ulcers ( Figure 1A ). Epstein-Barr Virus. Endoscopy showed disappeared small intestinal villi and an irregular vascular network ( Figure 1B ). And repeat enteroscopy showed that the villi of the small intestine were generally normal ( Figure 1C ).
case_images: Hematoxylin-eosin staining of the intestinal mucosal. (A) Hematoxylin-eosin staining of the colonic mucosa before colectomy. Colon pathology showed mucosal erosion, ulcers, cryptitis and granulation tissue hyperplasia. (B) Hematoxylin-eosin staining of the intestinal mucosa after colectomy. Ileum pathology showed villus atrophy and shortening, mucosal erosion, cryptitis with irregular crypt structure and infiltrated lymphocytes and plasma cells. (C) Hematoxylin-eosin staining of the intestinal mucosa after after 1 year of ustekinumab treatment. Ileum pathology showed a reduction in lymphocytes and plasma cells compared to before, with regular crypt structures.
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case_images: Histopathology showed chronic inflammation in the colonic mucosa, lamina propria edema, decreased number of glands, cryptitis and distortion of the crypt architecture ( Figure 2A ). Focal cryptitis of distorted shapes and reparative hyperplastic glands were observed ( Figure 2B ). Hematoxylin-eosin staining of the intestinal mucosa revealed a decrease in lymphocytes and plasma cells compared to before ( Figure 2C ).
case_images: The stool traits before and after treatment with ustekinumab. (A) The yellowish watery excreta before treatment. (B) The formed stool after ustekinumab treatment. (C) The stool from stoma was still formed over a one-year follow-up.
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case_images: On admission, daily stoma drainage was monitored at 5000-7000 mL/d of yellowish watery excretion ( Figure 3A ), with 2000 mL/d intake orally. The drainage volume from the stoma is 1000-1800 mL/d with oral intake of 2000- 2600 mL/d, and the stool trait was mushy and formed ( Figure 3B ). Over a one-year follow-up period, the patient gradually gained body weight, with the stoma drainage of formed brown stool ( Figure 3C ).
case_images: The therapeutic timeline of the patient. (A, B) Treatment protocol and changes in drainage volume. (C) Changes of body weight after treatment with ustekinumab. qd, quaque die. The patient was discharged from April 19th 2022 to July 7th 2023.
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case_images: The main treatment steps for the patient are shown in  Figures 4A-C .