Pneumatosis intestinalis in a patient with COVID-19.

A 73-year-old man with significant medical history including renal transplantation and chronic immunosuppression presented to the hospital with acute respiratory failure. His initial treatment included steroids for concern for Pneumocystis jiroveci pneumonia, although this was later excluded as the diagnosis. The patient's illness was consistent with COVID-19; however, he was not diagnosed with the virus until late in his course. The patient was found to have pneumatosis intestinalis that was successfully managed conservatively. Despite his multiple medical comorbidities, the patient had a positive outcome following COVID-19 infection. We discuss the association of pneumatosis intestinalis and COVID-19, and we investigate the various factors, including immunosuppression, that could play a role in this patient's successful recovery from the virus.

Pneumatosis intestinalis in COVID-19.

INTRODUCTION: COVID-19 is a respiratory illness due to novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), described in December 2019 in Wuhan (China) and rapidly evolved into a pandemic. Gastrointestinal (GI) tract can also be involved. CASE PRESENTATION: A 44-year-old man was hospitalised for COVID-19-associated pneumonia. A rapid recovery of respiratory and general symptoms was observed after 1 week of treatment with lopinavir/ritonavir plus hydroxychloroquine and broad-spectrum antibiotics (piperacillin-tazobactam plus teicoplanin). No GI symptoms were reported during hospitalisation, but a lung contrast-enhancement CT (CE-CT) excluding thromboembolism showed, as collateral finding, intraperitoneal free bubbles not present on a previous CT examination; the subsequent abdominal CE-CT described pneumatosis intestinalis (PI) involving the caecum and the right colon. Ciprofloxacin plus metronidazole was started, and the 2-week follow-up CT showed the complete resolution of PI. DISCUSSION: The pathogenesis of PI is poorly understood. PI involving the caecum and right colon has been described for HIV and Cytomegalovirus infections, but, to our best knowledge, never before in COVID-19. We hypothesise a multifactorial aetiopathogenesis for PI, with a possible role of the bowel wall damage and microbiota impairment due to SARS-CoV-2 infection, and we suggest a conservative management in the absence of symptoms.

Pneumatosis intestinalis in an SIV-infected rhesus macaque (Macaca mulatta).

Pneumatosis intestinalis (PI) has been described as an incidental finding in domestic animals and humans where it is associated with human immunodeficiency virus infection among other comorbidities. This report describes emphysematous changes consistent with PI in a simian immunodeficiency virus (SIV)-infected rhesus macaque (Macaca mulatta).

Norovirus: a possible cause of pneumatosis intestinalis.

OBJECTIVE: Pneumatosis intestinalis (PI) in children is associated with immunosuppression, mucosal disruption from trauma, obstructive pulmonary disease, congenital heart disease, and gastrointestinal infections. Our study is the first report of norovirus infection-associated PI. PATIENTS AND METHODS: A retrospective review was performed in pediatric patients (older than 30 days) with PI from March 2005 to April 2009. Since December 2008, in addition to routine stool examinations, reverse-transcriptase polymerase chain reaction testing for calicivirus (norovirus and sapovirus), adenovirus, astrovirus, and enterovirus has been performed. RESULTS: Twenty-seven patients with PI were identified. The median age was 1.4 (range 0.2-14.8 years). Seventeen patients (63.0%) were immunocompromised hosts. Pathogens were identified in 5 immunocompromised patients (5/27 and 5/8 since December 2008). Of note, norovirus was identified in 4 patients (80%, 4/5) during the cold weather season. The genotype of noroviruses in these patients was GII-4. Among 27 patients with PI, 10 patients (37.0%) developed PI in the spring and 11 (40.7%) in the winter. Twenty-four patients survived (88.9%, 24/27). None of the patients with norovirus or rotavirus infection died. CONCLUSIONS: Our data suggest that norovirus infection may contribute to the development of PI in immunocompromised hosts.

Asymptomatic pneumatosis intestinalis and free abdominal air in a patient with AIDS.

Detection of free abdominal air requires in most cases immediate surgical intervention. However, there may be situations, where invasive procedures are not indicated. We present a case of asymptomatic pneumatosis intestinalis and free abdominal air in a patient with Aids. Pneumatosis intestinalis is a rare entity with accumulation of subserosal or submucosal gas occurring in the small or large bowel. It has been reported in a variety of gastrointestinal disorders, in Aids, after transplantation, with steroid use, and in association with leukemia, lymphoma, vasculitis, collagen vascular disease and chronic obstructive pulmonary disease.