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Case report
Pneumatosis intestinalis in COVID-19
  1. Simone Meini1,
  2. Chiara Zini2,
  3. Maria Teresa Passaleva1,
  4. Anna Frullini1,
  5. Francesca Fusco2,
  6. Roberto Carpi2,
  7. Fiorella Piani1
  1. 1Medicina Interna, Azienda USL Toscana centro, Ospedale Santa Maria Annunziata, Firenze, Italy
  2. 2Radiologia, Azienda USL Toscana centro, Ospedale Santa Maria Annunziata, Firenze, Italy
  1. Correspondence to Dr Simone Meini; simonemeini2{at}gmail.com

Abstract

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.

  • bacterial overgrowth
  • clinical decision making
  • colonic diseases
  • colonic microflora
  • infectious disease
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgast-2020-000434

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    Footnotes

    • Contributors SM, AF, MTP and FP collected the clinical information. CZ, FF and RC selected the radiological images. SM and CZ wrote the main draft. MTP, AF, FP, FF and RC revised the manuscript. All authors approved the final version.

    • Funding OSMA ONLUS funded the article processing charges, but had no role in the preparation of the article, in the collection, analysis and interpretation of data, in the writing of the report, and in the decision to submit the article for publication.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data sharing not applicable as no datasets generated and/or analysed for this study. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.