A 46-year-old male patient was referred to our tertiary care hospital with multiple therapy refractory severely active ulcerative colitis (diagnosis since approximately 1 year). He was previously treated with infliximab, prednisolone, vedolizumab, filgotinib and mercaptopurine.

There was no significant medical history. Six weeks prior to admission at our ward, our patient was diagnosed with Kaposi sarcoma based on lesions on the feet and lower legs. His family history was positive for Crohn’s disease.

On admission, a sigmoidoscopy was performed, of which the images are shown below (figure 1). In anticipation of the pathology results, prednisolone was restarted without significant clinical effect.

Endoscopic view of the distal 25 cm of the colon and rectum.

Additionally, an ultrasound was performed to determine the extent of the inflammation, as this …