Remission of diffuse ulcerative duodenitis in a patient with ulcerative colitis after infliximab therapy: a case study and review of the literature

Abstract

Although ulcerative colitis (UC) is confined to colonic and rectal mucosa in a continuous fashion, recent studies have also demonstrated the involvement of upper gastrointestinal tract as diagnostic endoscopy becomes more available and technically advanced. The pathogenesis of UC is not well established yet. It might be associated with an inappropriate response of host mucosal immune system to gut microflora. Although continuous and symmetric distribution of mucosal inflammation from rectum to colon is a typical pattern of UC, clinical feature and course of atypically distributed lesions in UC might also help us understand the pathogenesis of UC. Herein, we report a case of duodenal involvement of UC which successfully remitted after infliximab therapy. Endoscopic and pathologic findings before and after administration of anti-tumor necrosis factor suggest that the pathogenesis of upper gastrointestinal involvement of UC may be similar to that of colon involvement.

Keywords: Colitis, ulcerative; Duodenitis; Remission.

Fig. 1.

Endoscopic findings. (A) At initial colonoscopy, diffuse ulcerative inflammation with profuse exudation and spontaneous mucosal hemorrhage. (B) At 3 months follow-up colonoscopy after induction therapy with infliximab, mucosal healing showing whitish scar formation was noted. (C) At initial esophagogastroduodenoscopy (EGD), diffuse edematous and ulcerative inflammation on the bulb and 2nd portion of duodenum. (D) At 3 months follow-up EGD after infliximab induction therapy, endoscopic mucosal healing was achieved on the duodenal mucosa showing scar change.

Fig. 2.

Histopathological findings. (A) High-power magnification of duodenum showing histologic features of chronic active duodenitis. There is a manifestation of chronic active colitis with crypt distortion, basal lymphoplasmacytosis and crypt abscess (H&E stain, ×200). (B) High-power magnification of duodenum after infliximab treatment. Note the decreased density of inflammatory cell infiltrates in lamina propria as well as decreased active inflammation compared to those of prior medical treatment. Instead of prominent inflammatory cell infiltrates, subepithelial fibrosis is also noted (H&E stain, ×200).