case_images: PMC7550934_01
case_images: Endoscopy (upper images) and corresponding histology findings (lower image)
  in the distal sigmoid area during the course of the cyclosporin/ustekinumab
  therapy. (A) Before initiation of cyclosporin therapy, there are multiple
  superficial mucosal ulcers and spontaneous bleeding as signs of severe
  endoscopic disease. (B) Histology findings indicate signs of severe acute
  and chronic inflammation with architectural disorders, surface erosions and
  ulcerations. (C) At 8 weeks after initiating combination therapy with
  cyclosporin and ustekinumab, there is mucosal erythema and decreased
  vascular pattern as signs of mild endoscopic inflammation. (D) Histology
  demonstrates changes compatible with moderate inflammation. The surface
  appears intact, and there is moderate chronic and less acute cell
  infiltration with neutrophils and some eosinophils, granulocytic cells as
  well as plasmocytic infiltration and less mucin depletion. Furthermore, mild
  architectural disorder with interstitial, sometimes scar-like, fibrosis. (E)
  Under ongoing ustekinumab maintenance monotherapy, there is endoscopic
  remission with normal mucosal appearance. (F) Histology indicates mild
  mucosal inflammation with an intact surface, moderate chronic and just few
  signs of acute inflammation with regressive infiltration of neutrophils and
  just few eosinophilic granulocytes, as well as few plasmocytic cells and no
  mucin depletion. Mild architectural disorder with interstitial, sometimes
  scar-like, fibrosis. Histological images (20x) were taken using a Leica DM
  4000 B microscope (Leica Microsystems, Wetzlar, Germany) with Jenoptik
  Progres Gryphax SUBRA camera (Jenoptik, Jena, Germany).
case_images: 10.1177_1756284820954112-fig1.jpg
case_images: PMC7550934_01_10.1177_1756284820954112-fig1.jpg
case_images: fig1-1756284820954112
case_images: Upon admission, sigmoidoscopy showed signs of severe endoscopic inflammation (endoscopic Mayo score: 3) with spontaneous bleeding and extended superficial mucosal ulcerations (Figure 1A) and histology confirmed severe inflammation (Geboes score: 5) (Figure 1B). Endoscopy demonstrated signs of only mild mucosal disease (endoscopic Mayo score: 1) with mucosal erythema and decreased vascular pattern (Figure 1C), while histology also confirmed mild inflammation (Geboes score: 3) (Figure 1D). Sigmoidoscopy demonstrated endoscopic remission (endoscopic Mayo score: 0) without signs of active inflammation (Figure 1E) and histology just showed signs of mild inflammatory activity (Geboes score: 2) (Figure 1F).