COVID-19 infection masquerading as inflammatory bowel disease

ABSTRACT

Introduction: Although COVID-19 infection has been associated with GI manifestations like nausea, vomiting, diarrhea, and even transaminitis, there is no known association between this virus and inflammatory bowel disease (IBD). Here we present the case of COVID-19 infection masquerading as IBD. We describe the instance of a COVID-19 patient with hematochezia, found to have histological changes similar to IBD on colon biopsy. Case Description/Methods: A 70 year-old female with PMH of HTN, DM, CAD, COPD, and recently diagnosed poorly differentiated colonic adenocarcinoma with signet ring features (statuspost hemicolectomy and chemotherapy), presented to the ED with hypotension in the setting of nausea, vomiting, and diarrhea for 5 days. Patient had been started on chemotherapy two weeks prior and was found to have a blood pressure of 76/53, but was afebrile with no signs of tachycardia or hypoxia. Labs were significant for a white blood cell count of 0.67 (absolute neutrophil count 247), platelets of 115, lactate of 0.9, potassium of 6.2, BUN/creatinine of 88/5.6, and CRP of 20.78. COVID- 19 PCR was positive. Abdominal CT identified non-specific ileitis, and GI was consulted due to concern for neutropenic enteritis and ileus. During the hospital stay, she developed hematochezia with a drop in hemoglobin. C. diff and GI PCR were negative. A colonoscopy was performed which showed patchy areas of edema, erythema, and ulceration (Figure 1B). Colon biopsies revealed crypt abscesses, consistent with IBD (Figure 1C). However, prior colonoscopy 4 months ago, which identified colon cancer, did not find any evidence of IBD (Figure 1A). Patient clinically declined, ultimately dying of acute hypoxic respiratory failure. Discussion: Given this patient's age and the fact that she had previously had a colonoscopy that did not show evidence of crypt abscesses, it is unlikely she developed a new diagnosis of inflammatory bowel disease in the interim. It is more likely that the crypt abscesses noted on colon biopsy were due to COVID-19 infection. One study found that of 651 patients with COVID-19, 11.4% exhibited GI symptoms, most often developing acute gastritis or enteritis. We present this case to raise awareness of an unprecedented phenomenon in COVID-19 infection .