Neutropenic Enterocolitis and Rapid Spontaneous Resolution of Portal Venous Gas: A Non-Respiratory Manifestation of COVID-19

Abstract

The COVID-19 pandemic is affecting millions across the globe. The population of immunosuppressed individuals are at greatest risk of morbidity and mortality. Data on COVID-19 induced illness in the immunocompromised host are sparse. We aim to highlight the possibility of atypical and non-respiratory presentations of COVID-19 (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) in immunosuppressed individuals as our case reveals a rare COVID-19 associated GI presentation of neutropenic enterocolitis with bloody diarrhea.

COVID-19-associated pancytopenia and typhlitis

“…Abdominal CT is beneficial in diagnosing typhlitis and can demonstrate circumferential bowel wall thickening and edema in the relevant bowel segments (usually in the cecum and ascending colon) and peri-intestinal fat-stranding. Moreover, bowel wall thickening is the most sensitive imaging finding and is sufficient to suggest typhlitis diagnosis in the correct clinical and laboratory findings [ 1 , 2 , 7 ]. Rehman et al [ 7 ] recently reported an immunosuppressed patient with COVID-19 and typhlitis, whose general condition deteriorates rapidly.…”

“…Moreover, bowel wall thickening is the most sensitive imaging finding and is sufficient to suggest typhlitis diagnosis in the correct clinical and laboratory findings [ 1 , 2 , 7 ]. Rehman et al [ 7 ] recently reported an immunosuppressed patient with COVID-19 and typhlitis, whose general condition deteriorates rapidly. Similarly, the clinical condition deteriorated rapidly in the present case, and the patient was died.…”

“…Typhlitis is treated conservatively with broad-spectrum antibiotics and parenteral nutrition. In case of failure of conservative treatment or the presence of complications such as bowel perforation, surgery can be performed [ 7 , 8 ].…”

“…Moreover, reports of gastrointestinal system involvement in COVID-19 patients are rapidly increasing. Recently, Rehman and colleagues [ 7 ] reported a case of COVID-19 and neutropenic enterocolitis in an immunosuppressed patient with esophageal adenocarcinoma. Herein, we aimed to present clinical and radiological findings of a rare patient, who was not previously immunosuppressed, with COVID-19-associated pancytopenia and typhlitis.…”

Colitis isquémica y neumatosis intestinal en paciente con COVID-19: reporte de caso

“…Dentro de los reportes de tiflitis asociados a COVID-19, existe un caso de desarrollo de esta entidad con un conteo de neutrófilos mayor a 1000 / µl, que es otra característica única de la enterocolitis inducida por COVID-19 (18) . Este paciente no presentó neutropenia al igual que el de nuestro caso.…”