Cytomegalovirus haemorrhagic enterocolitis associated with severe infection with COVID-19

Warren C. Carll, Mohamed Y. Rady, Marcela A. Salomao, Bhavesh Patel, Vijay P. Singh, Ayan Sen

Research output: Contribution to journalArticlepeer-review

Abstract

We present a case of haemorrhagic enterocolitis in a patient with SARS-CoV-2 who recovered from respiratory failure after support with venovenous extracorporeal membrane oxygenation. We describe clinicopathological features consistent with the systemic coinfection/reactivation of cytomegalovirus (CMV) concurrent with COVID-19 infection and the protracted clinical course of resolution of gastrointestinal inflammation after the treatment of CMV infection. Stool PCR, abdominal CT perfusion scan and histological examination of ileal and colonic tissues excluded enterocolitis secondary to other causes of infection (common viral, bacterial and protozoal gastrointestinal pathogens), macrovascularand microvascular ischaemia and classic inflammatory bowel disease, respectively. We propose possible synergistic pathophysiologic mechanisms for enterocolitis complicating severe COVID-19 infection: (1) T lymphocyte depletion and immune response dysregulation, (2) use of immunomodulators in the management of severe COVID-19 infection and (3) high concentration of ACE-2 receptors for COVID-19 virus in the gastrointestinal tract.

Original languageEnglish (US)
Article number000556
JournalBMJ Open Gastroenterology
Volume8
Issue number1
DOIs
StatePublished - Jan 12 2021

Keywords

  • enteric infections
  • gut inflammation
  • histopathology

ASJC Scopus subject areas

  • Gastroenterology

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