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 hospital...
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| Language: | English |
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BMJ Publishing Group
2020-12-01
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| Series: | BMJ Open Gastroenterology |
| Online Access: | https://bmjopengastro.bmj.com/content/7/1/e000434.full |
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| author | Simone Meini Chiara Zini Maria Teresa Passaleva Anna Frullini Francesca Fusco Roberto Carpi Fiorella Piani |
| author_facet | Simone Meini Chiara Zini Maria Teresa Passaleva Anna Frullini Francesca Fusco Roberto Carpi Fiorella Piani |
| author_sort | Simone Meini |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-601d73be2cbb450c90c3e64824e8ee95 |
| institution | DOAJ |
| issn | 2054-4774 |
| language | English |
| publishDate | 2020-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Gastroenterology |
| spelling | doaj-art-601d73be2cbb450c90c3e64824e8ee952025-08-20T02:39:12ZengBMJ Publishing GroupBMJ Open Gastroenterology2054-47742020-12-017110.1136/bmjgast-2020-000434Pneumatosis intestinalis in COVID-19Simone Meini0Chiara Zini1Maria Teresa Passaleva2Anna Frullini3Francesca Fusco4Roberto Carpi5Fiorella Piani6Medicina Interna, Azienda USL Toscana centro, Ospedale Santa Maria Annunziata, Firenze, ItalyRadiologia, Azienda USL Toscana centro, Ospedale Santa Maria Annunziata, Firenze, ItalyMedicina Interna, Azienda USL Toscana centro, Ospedale Santa Maria Annunziata, Firenze, ItalyMedicina Interna, Azienda USL Toscana centro, Ospedale Santa Maria Annunziata, Firenze, ItalyRadiologia, Azienda USL Toscana centro, Ospedale Santa Maria Annunziata, Firenze, ItalyRadiologia, Azienda USL Toscana centro, Ospedale Santa Maria Annunziata, Firenze, ItalyMedicina Interna, Azienda USL Toscana centro, Ospedale Santa Maria Annunziata, Firenze, ItalyIntroduction 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.https://bmjopengastro.bmj.com/content/7/1/e000434.full |
| spellingShingle | Simone Meini Chiara Zini Maria Teresa Passaleva Anna Frullini Francesca Fusco Roberto Carpi Fiorella Piani Pneumatosis intestinalis in COVID-19 BMJ Open Gastroenterology |
| title | Pneumatosis intestinalis in COVID-19 |
| title_full | Pneumatosis intestinalis in COVID-19 |
| title_fullStr | Pneumatosis intestinalis in COVID-19 |
| title_full_unstemmed | Pneumatosis intestinalis in COVID-19 |
| title_short | Pneumatosis intestinalis in COVID-19 |
| title_sort | pneumatosis intestinalis in covid 19 |
| url | https://bmjopengastro.bmj.com/content/7/1/e000434.full |
| work_keys_str_mv | AT simonemeini pneumatosisintestinalisincovid19 AT chiarazini pneumatosisintestinalisincovid19 AT mariateresapassaleva pneumatosisintestinalisincovid19 AT annafrullini pneumatosisintestinalisincovid19 AT francescafusco pneumatosisintestinalisincovid19 AT robertocarpi pneumatosisintestinalisincovid19 AT fiorellapiani pneumatosisintestinalisincovid19 |