A 31-year-old woman developed recurrent aphthous ulcers in her mouth starting at the age of 16 years and recurrent vulvar ulcers starting at the age of 21 years. She had been treated with small doses of prednisone and THD for a short period, but the ulcers recurred after withdrawal. In December 2020, she was admitted to the digestive department of a local hospital because of abdominal pain. Laboratory test results were as follows: ESR, 32 mm/h; CRP, 15 mg/L. Endoscopy revealed an ulcer in the ileocecal region. Pathology showed acute and chronic inflammation accompanied by tissue necrosis, inflammatory cell infiltration, small vessel proliferation, no acid-fast bacilli, and no tumor cells. The patient was diagnosed with intestinal BS.
The patient was treated with prednisone (50 mg/day) and SASP. After 3 months, the prednisone dose was reduced to 20 mg daily. Owing to persistent abdominal pain, she was treated with CTX (100 mg PO once every other day). The patient's abdominal symptoms were not significantly relieved. The patient was admitted to our hospital in August 2021 owing to aggravation of abdominal pain. She had lost 4 kg in the past two months. Laboratory test results were as follows: fecal occult blood test, positive; HGB, 86 g/L; ESR, 35 mm/h; CRP, 23.4 mg/L. Tuberculosis and the tumor were ruled out. Abdominal CT showed thickening and roughness of the ileocecal wall, which was considered an inflammatory change. On August 17, 2021, enteroscopy showed that an ulcer with a size of about 4.0 cm x 1.2 cm in the ring 2/3 cavity was found near the ileocecal valve, which was characterized by white scar in the local mucosa, congestion and edema in the surrounding mucosa ( Figure 1D ). Pathological examination revealed acute and chronic inflammation of the mucosal tissue. The patient's DAIBD score was 80.
The patient was treated with prednisone (50 mg PO daily), TOF (5 mg PO twice a day), SASP, and THD (discontinuation due to obvious reduction in menstrual volume). After two weeks, the abdominal pain gradually subsided. Subsequently, the prednisone dose was gradually reduced to 2.5 mg daily. In December 2021, enteroscopy revealed that the ileocecal ulcer had healed, and the patient's DAIBD score, ESR, and CRP levels were normal ( Figure 2 ).