Association between gastrointestinal cytomegalovirus infection and COVID-19 infection

ABSTRACT

BackgroundCoronavirus disease 2019 (COVID-19), which was first reported in Wuhan City, China, is a major public health burden worldwide. Systemic corticosteroid therapy is an effective treatment for severe COVID-19 with ARDS. It ameliorates COVID-19-induced cytokine storm and improves patient outcomes;however, it can trigger immunosuppression, which causes a myriad of secondary infections.MethodsFifteen patients suffering from gastrointestinal complaints during COVID-19 related illness underwent gastroscopic/colonoscopic examination.ResultsWe report 15 cases of gastrointestinal (GI) Cytomegalovirus (CMV) infection diagnosed on biopsy. The mean age at diagnosis was 57 years;13 were males and 2 were females. The most common presentation was bleeding per rectum in 12 patients, dysphagia in 2 patients and abdominal pain in 1 patient. The most common site was the colon seen in 10 patients, 1 patient had Ileo-caecal valve involvement, and 2 each had gastric and esophageal involvement. Among colonic involvement, 2 patients had pan-colonic involvement. Out of 15 patients, 9 patients had either past history of steroid intake or ongoing intake for COVID-19 associated lung injury. Nine patients were diabetic, and 2 were suffering from chronic liver disease.ConclusionsImmunosuppressive state inhibits the activity of crucial transcriptional regulators of proinflammatory genes and reducing lymphocyte levels. Therefore, exposure to systemic corticosteroids can be a risk factor for CMV infection in patients with severe COVID-19.