A severe coronavirus disease 2019 patient with high-risk predisposing factors died from massive gastrointestinal bleeding: a case report

Abstract

Background SARS-CoV-2 is highly infectious and has been a significant public health threat. Despite typical manifestations of illness are dominated by respiratory symptom, some patients have concurrent gastrointestinal manifestations, including nausea, diarrhea, and vomiting. Massive gastrointestinal bleeding, however, has rarely been reported. Case presentation We herein described a case of severe SARS-CoV-2 infected patient with several risk factors for poor prognosis, including male, hypertension, old age, mixed bacterial infection and multilobular infiltration on radiological imaging. After improvement of respiratory status, the onset of gastrointestinal bleeding occurred, probably resulting from direct viral invasion as evidenced by the positive findings for SARS-CoV-2 in the repeat stool specimens. Although aggressive resuscitation was administered, hematochezia was uncontrolled. The patient rapidly deteriorated, suffered from cardiac arrest, and expired. Conclusions Digestive symptoms could be severe in SARS-CoV-2 infected patients, especially for the high-risk individuals with predisposing conditions. A more thorough protocol for preventing cross-infection through faecal-oral transmission should be implemented in the process of patient care and infection control.

COVID-19 in gastroenterology and hepatology: Lessons learned and questions to be answered

“…A well-known complication related to viral illness, altered taste sensation, was present in almost half of the patients (49.8%) with COVID-19[ 22 ]. Chen et al [ 24 ] described a critically ill COVID-19 patient in whom acute respiratory distress syndrome progressed rapidly but who ultimately died from massive GI bleeding even after improvement of the respiratory status. In this patient, the repeat real-time reverse transcriptase PCR SARS-CoV-2 test was positive in stool rather than respiratory specimens, indicating direct and continuous viral invasion of the GI tract.…”

Untitled

“…Therefore, it should be noted that the most common gastrointestinal manifestations associated with SARS-CoV-2 include nausea, vomiting, abdominal pain and diarrhea. Gastrointestinal bleeding and changes in liver enzymes alanine transferase (ALT) and aspartate transferase (AST) have also been reported [37]. A study in California revealed that GI symptoms affect approximately 31.9% of patients, with anorexia, nausea / vomiting and diarrhea being the most common and mildly described [38].…”

“…A study in California revealed that GI symptoms affect approximately 31.9% of patients, with anorexia, nausea / vomiting and diarrhea being the most common and mildly described [38]. Other studies show reports of patients who presented with gastrointestinal symptoms as the only manifestation of COVID-19 [37,39], a fact that stands out the importance of their understanding. Furthermore, in the province of Zhejiang, China, it was observed that 11% of the cases of COVID-19 had gastrointestinal manifestations, the most common being diarrhea affecting about 70% of the patients with gastrointestinal symptoms and 8% of the total cases.…”

Gastrointestinal Manifestations of COVID-19: An Overview

“…Therefore, it should be noted that the most common gastrointestinal manifestations associated with SARS-CoV-2 include nausea, vomiting, abdominal pain and diarrhea. Gastrointestinal bleeding and changes in liver enzymes alanine transferase (ALT) and aspartate transferase (AST) have also been reported [37]. A study in California revealed that GI symptoms affect approximately 31.9% of patients, with anorexia, nausea / vomiting and diarrhea being the most common and mildly described [38].…”

“…A study in California revealed that GI symptoms affect approximately 31.9% of patients, with anorexia, nausea / vomiting and diarrhea being the most common and mildly described [38]. Other studies show reports of patients who presented with gastrointestinal symptoms as the only manifestation of COVID-19 [37,39], a fact that stands out the importance of their understanding. Furthermore, in the province of Zhejiang, China, it was observed that 11% of the cases of COVID-19 had gastrointestinal manifestations, the most common being diarrhea affecting about 70% of the patients with gastrointestinal symptoms and 8% of the total cases.…”