JPGN

JPGN

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A 17-year-old male, with ileocecal Crohn's disease since age 12 years, underwent endoscopic evaluation for loss of response to infliximab and methotrexate maintenance therapy. Colonoscopy revealed a large cecal ulcer adjacent to the ileocecal valve (Figure 1a). Ileocecal resection was performed Histopathological examination of the surgical specimen including EBER (EBV encoded RNA) in situ hybridization (1b-d) is presented.

What is the next best management step?

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    A) Watch and wait
    B) Starting chemotherapy
    C) Discontinuation of immunosuppressive therapy
    D) Increasing immunosuppression therapy