{
  "abstract": "A 26-year-old man presented with a 2-month history of intermittent haematochezia and fever. His symptoms began in June 2023 with fever (37.2–38.6°C) and diarrhoea, which resolved with antibiotics, but recurred in July 2023 with lower grade fever (37.2–37.6°C), diarrhoea and bloody mucus. Laboratory tests showed leucocytosis (white cell count: 15.3×109/L) and neutrophilia (79.9%). Gastroscopy revealed polypoid prominences of varying sizes and shapes (ranging from approximately 0.2 cm to 1.2 cm) in the descending duodenum (figure 1A). Colonoscopy showed scattered round and oval ulcers of varying sizes throughout the colon. The bases of the ulcers were covered with necrotic ulcer base, the surrounding mucosa was congested and swollen and the mucosa between the ulcers was smooth (figure 1B,C). The pathological examination revealed that the duodenal polyps presented with chronic mucosal inflammation along with the formation of lymphoid follicles. Meanwhile, the colon ulcers were characterised by chronic active mucosal inflammation, accompanied by ulceration and lymphoid tissue hyperplasia. CT enterography revealed intestinal inflammation, characterised by enlarged lumens with a maximal diameter of 6 cm and unevenly thickened walls (up to 1.5 cm at their thickest point) in the ileocaecal region, ascending colon and transverse colon. Contrast enhancement was relatively uniform. While these findings share some features with Crohn’s disease (CD), they lack the characteristic segmental distribution typically seen in CD (figure 1D-F). Laboratory tests were negative for hepatitis B antibody, hepatitis C antibody, HIV antibody, syphilis antibody, Clostridioides difficile toxin and tuberculosis T-cell test. Although the PCR results for cytomegalovirus-DNA and Epstein-Barr virus (EBV)-DNA were negative, EBV was detected by metagenomic next-generation sequencing (mNGS). This may be related to the ultra-high sensitivity of mNGS. Since the patient had fever, leucocytosis (white cell count: 15.3×10⁹/L) and neutrophilia (79.9%), and since mNGS indicated EBV infection, we used ganciclovir, ceftriaxone and ornidazole for treatment. However, the cause of colonic ulcers and the relationship between duodenal polyps and these ulcers remained unclear. Four-month follow-up on 24 January 2024 revealed similar findings. In the descending duodenum, scattered polypoid elevations of various sizes (1.2 cm at largest, 0.2 cm at smallest) showed little change from before (figure 1G). Pathology indicated chronic inflammation of the small intestine mucosa with marked lymphoid tissue hyperplasia and lymphoid follicle formation, consistent with reactive hyperplasia mainly of T-lymphocytes (figure 1H). The ileocaecal valve, appendix opening and about 15 cm of the terminal ileum were normal. The entire colon had scattered round and oval ulcers, punctate hyperaemia and white scars, especially prominent in the ascending colon and rectum (figure 1I,J). Pathology confirmed severe chronic active inflammation of the mucosa with ulcer formation (figure 1K).",
  "authors": [
    {
      "affiliations": [
        "Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China"
      ],
      "name": "Ben Wang"
    },
    {
      "affiliations": [
        "Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China"
      ],
      "name": "Bingjie Jin"
    },
    {
      "affiliations": [
        "Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China"
      ],
      "name": "Jinghua Hao"
    }
  ],
  "title": "Patient with multiple duodenal polyps and multiple colonic ulcers: the same or different conditions?",
  "uid": "a955c659-79c9-5a4c-b8d0-eb74598fdf42"
}