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Dtsch Med Wochenschr ; 146(9): 598-602, 2021 Apr.
Article in German | MEDLINE | ID: covidwho-1127198


INTRODUCTION: Multisystem Inflammatory Syndrome is a rare condition that affects multiple organs following SARS-CoV-2 infection. It was first observed in children, however few cases of adults with Multisystem Inflammatory Syndrome (MIS-A) were published in the US and the UK. We present two cases of Multisystem Inflammatory Syndrome in adults which occurred in Germany. HISTORY: #1: A 27-year-old male presented with fever (40 °C), right lower abdominal pain, diarrhea and peritonism. #2: A 21-year-old female presented with fever (40 °C) occipital headaches, neck stiffness, and somnolence. FINDINGS: #1: Increased inflammation parameters and elevated Nt-proBNP were found. Abdominal CT showed signs of ileitis terminalis and colitis. Crohn's disease was excluded endoscopically. Echocardiography showed minor pericardial effusion. A SARS-CoV-2 antibody test was positive. #2: Increased inflammation parameters and an increased Nt-proBNP were found. Cranial CT showed pathology. Meningitis was excluded via lumbar puncture. Thoracic CT and abdominal ultrasound showed no signs of infection. Echocardiography showed reduced LVEF (50 %). A SARS-CoV-2 antibody test was positive. THERAPY AND COURSE: #1: Antibiotic therapy as well as oral prednisolone didn't improve the clinical course. High-dose vasopressor therapy was necessary. The clinical condition improved only after adding hydrocortisone therapy. #2 Despite antibiotic therapy the clinical condition deteriorated. Because of insufficient effect of hydrocortisone, high-dose immunoglobulins were administered. Consequently, symptoms improved and LVEF normalized. CONCLUSIONS: Multisystem Inflammatory Syndrome presents as a chameleon of symptoms. In the context of the ongoing SARS-CoV-2 pandemic, rising numbers of cases in adults can be expected. In patients with fever, increased inflammation parameters and lack of other explanations, Multisystem Inflammatory Syndrome must be considered. Due to the potential severity of clinical courses and possible cardiac involvement, a therapy with hydrocortisone, ASS and immunoglobulins should be considered early.

COVID-19 , Systemic Inflammatory Response Syndrome , Adult , COVID-19/complications , COVID-19/diagnosis , COVID-19/therapy , Female , Germany , Humans , Male , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/therapy , Systemic Inflammatory Response Syndrome/virology , Tomography, X-Ray Computed , Young Adult
Chirurg ; 92(1): 30-33, 2021 Jan.
Article in German | MEDLINE | ID: covidwho-976992


In order to improve the care of patients with chronic inflammatory bowel diseases during the coronavirus disease 2019 (COVID-19) pandemic, the currently valid guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS) on Crohn's disease and ulcerative colitis were extended within a virtual conference to include current and practically relevant recommendations. The addendum addresses in particular the risk of COVID-19 infections in patients with chronic inflammatory bowel diseases, the diagnostics under the conditions of the pandemic, the consequences for the pharmacotherapy and operative treatment of the underlying disease. It also addresses general measures for protection against infections and for adjunctive treatment of patients with chronic inflammatory bowel diseases.

COVID-19 , Colitis, Ulcerative , Crohn Disease , Inflammatory Bowel Diseases , Humans , Pandemics , SARS-CoV-2
Z Gastroenterol ; 58(10): 982-1002, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-886826


The COVID-19 pandemic is a global outbreak of new onset infections with the SARS-CoV-2 virus. To date, more than 3.4 million people have been infected throughout the world. In Germany, approximately 450,000 patients suffer from inflammatory bowel disease; these patients generally require continuous expert care and support. Against the background of a rapidly accumulating knowledge base on SARS-CoV-2, 68 expert authors of the current DGVS guidelines for Crohn's disease and ulcerative colitis took part in a virtual meeting to compile up-to-date, practice-orientated recommendations aimed at improving the care of patients with IBD. These recommendations address the risk of infection, including the risk for specific patient groups, the possible course of the disease, and consequences for pharmacological and surgical therapies of the underlying disease, as well as general measures for infection prevention and adjuvant prophylactic and therapeutic options.

Colitis, Ulcerative , Coronavirus Infections , Crohn Disease , Inflammatory Bowel Diseases , Pneumonia, Viral , Practice Guidelines as Topic , Betacoronavirus , COVID-19 , Colitis, Ulcerative/diagnosis , Colitis, Ulcerative/therapy , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Crohn Disease/diagnosis , Crohn Disease/therapy , Germany , Humans , Inflammatory Bowel Diseases/diagnosis , Inflammatory Bowel Diseases/therapy , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2