First case report of exacerbated ulcerative colitis after anti-interleukin-6R salvage therapy

Figure 1 Endoscopic and endomicroscopic evaluation of the mucosa before and after anti-interleukin-6R therapy. Endoscopy of the sigmoid mucosa of the patient before anti-interleukin (IL)-6R therapy showed strong signs of mucosal inflammation (A); Mayo endoscopy score = 3; Evaluation of the sigmoid after 12 wk of tocilizumab treatment revealed augmented signs of mucosal inflammation and progressive ulcer formation. Mayo endoscopy score = 3 (B); Endomicroscopy with a probe based system (Mauna Kea System) of the sigmoid mucosa of the patient before (C); and after 12 wk of anti-IL-6R therapy (D). There was a marked increase in mucosal inflammation with increased leakage, dilatation of microvessels and disturbed crypt architecture.