Article Text

Cytomegalovirus haemorrhagic enterocolitis associated with severe infection with COVID-19
  1. Warren C Carll1,
  2. Mohamed Y Rady2,
  3. Marcela A Salomao3,
  4. Bhavesh Patel2,
  5. Vijay P Singh4,
  6. Ayan Sen2
  1. 1Departments of Pulmonary and Critical Care Medicine, Mayo Clinic Hospital, Phoenix, Arizona, USA
  2. 2Department of Critical Care Medicine, Mayo Clinic Hospital, Phoenix, Arizona, USA
  3. 3Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
  4. 4Division of Gastroenterology and Hepatology, SC Johnson Research Building, Mayo Clinic Arizona, Scottsdale, Arizona, USA
  1. Correspondence to Professor Mohamed Y Rady; rady.mohamed{at}mayo.edu

Abstract

We present a case of haemorrhagic enterocolitis in a patient with SARS-CoV-2 who recovered from respiratory failure after support with venovenous extracorporeal membrane oxygenation. We describe clinicopathological features consistent with the systemic coinfection/reactivation of cytomegalovirus (CMV) concurrent with COVID-19 infection and the protracted clinical course of resolution of gastrointestinal inflammation after the treatment of CMV infection. Stool PCR, abdominal CT perfusion scan and histological examination of ileal and colonic tissues excluded enterocolitis secondary to other causes of infection (common viral, bacterial and protozoal gastrointestinal pathogens), macrovascular and microvascular ischaemia and classic inflammatory bowel disease, respectively. We propose possible synergistic pathophysiologic mechanisms for enterocolitis complicating severe COVID-19 infection: (1) T lymphocyte depletion and immune response dysregulation, (2) use of immunomodulators in the management of severe COVID-19 infection and (3) high concentration of ACE-2 receptors for COVID-19 virus in the gastrointestinal tract.

  • enteric infections
  • gut inflammation
  • histopathology
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Footnotes

  • Correction notice This article has been corrected since it published online to fix a spacing issue in abstract.

  • Contributors WCC participated in the concept or design of the work; or acquisition, analysis or interpretation of data; drafting the work or revising it critically for important intellectual content; approval of the version to be published and participated sufficiently in the work to take public responsibility for appropriate portions of the content. MYR participated in the concept or design of the work; or acquisition, analysis or interpretation of data; drafting the work or revising it critically for important intellectual content; approval of the version to be published and participated sufficiently in the work to take public responsibility for appropriate portions of the content. MAS participated in the concept or design of the work; or acquisition, analysis or interpretation of data; drafting the work or revising it critically for important intellectual content; approval of the version to be published and participated sufficiently in the work to take public responsibility for appropriate portions of the content. BP participated in the concept or design of the work; or acquisition, analysis or interpretation of data; drafting the work or revising it critically for important intellectual content; approval of the version to be published and participated sufficiently in the work to take public responsibility for appropriate portions of the content. VPS participated in the concept or design of the work; or acquisition, analysis or interpretation of data; drafting the work or revising it critically for important intellectual content; approval of the version to be published and participated sufficiently in the work to take public responsibility for appropriate portions of the content. AS participated in the concept or design of the work; or acquisition, analysis or interpretation of data; drafting the work or revising it critically for important intellectual content; approval of the version to be published and participated sufficiently in the work to take public responsibility for appropriate portions of the content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval Our Institutional Review Board does not require approval for reporting individual case or case series.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplemental information.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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