key: cord-0772322-atr9wcx7
authors: Cho, M.; Liu, W.; Balzora, S.; Suarez, Y.; Hoskoppal, D.; Theise, N. D.; Cao, W.; Sarkar, S. A.
title: Clinical and intestinal histopathological findings in SARS-CoV-2/COVID-19 patients with hematochezia
date: 2020-08-07
journal: nan
DOI: 10.1101/2020.07.29.20164558
sha: a8df1fa3dbcbabc9bd86ff06e75c6ee133a2ccf2
doc_id: 772322
cord_uid: atr9wcx7

Gastrointestinal (GI) symptoms of SARS-CoV2/COVID-19 in the form of anorexia,nausea, vomiting, abdominal pain and diarrhea are usually preceeded by respiratory manifestations and are associated with a poor prognosis. Hematochezia is an uncommon clinical presentation of COVID-19 disease and we hypothesize that older patients with significant comorbidites (obesity and cardiovascular) and prolonged hospitalization are suspectible to ischemic injury to the bowel. We reviewed the clinical course, key laboratory data including acute phase reactants, drug/medication history in two elderly male patients admitted for COVID-19 respiratory failure. Both patients had a complicated clinical course and suffered from hematochezia and acute blood loss anemia requiring blood transfusion around day 40 of their hospitalization. Colonoscopic impressions were correlated with the histopathological findings in the colonic biopies and changes compatible with ischemia to nonspecific acute inflammation, edema and increased eosinophils in the lamina propria were noted.Both patients were on anticoagulants, multiple antibiotics and antifungal agents due to respiratory infections at the time of lower GI bleeding. Hematochezia resolved spontaneously with supportive care. Both patients eventually recovered and were discharged. Elderly patients with significant comorbid conditions are uniquely at risk for ischemic injury to the bowel. Hypoxic conditions due to COVID-19 pneumonia and respiratory failure, compounded by preexisting cardiovascular complications, and/or cytokine storm orchestrated by the viral infection leading to alteration in coagulation profile and/or drug/medication injury can be difficult to distinguish in these critically ill patients. Presentation of hematochezia may further increase the mortality and morbidity of COVID-19 patients, and prompt consultation and management by gastroenterology is therefore warranted.

Gastrointestinal (GI) symptoms of SARS-CoV2/COVID-19 in the form of anorexia, 27 nausea, vomiting, abdominal pain and diarrhea are usually preceeded by respiratory 28 manifestations and are associated with a poor prognosis. Hematochezia is an uncommon 29 clinical presentation of COVID-19 disease and we hypothesize that older patients with 30 significant comorbidites (obesity and cardiovascular) and prolonged hospitalization are 31 suspectible to ischemic injury to the bowel. 32 We reviewed the clinical course, key laboratory data including acute phase reactants, perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version posted August 7, 2020. . https://doi.org/10.1101/2020.07.29.20164558 doi: medRxiv preprint department with fever and chills for 8 days and cough with shortness of breath for 3 77 days. The patient received hydroxychloroquine and azithromycin from his primary care 78 provider for presumed COVID-19 infection but discontinued by the patient after a few 79 days. On admission, nasopharyngeal swab was positive for SARS-CoV-2 virus. COVID-19 80 pneumonia was complicated by acute hypoxic respiratory failure requiring intubation.

His nasal swab was also positive for methicillin-susceptible staphylococcus aureus. perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version posted August 7, 2020. perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version posted August 7, 2020. perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version posted August 7, 2020. Table 1 and 2) or as a consequence of tissue damage 153 secondary to an immune response, rather than a direct interaction of these epithelial Gastroenterology and Hepatology, NYU Langone Health for their support and assitance.

Every precaution has been taken to protect the privacy of research subjects and the 173 All rights reserved. No reuse allowed without permission. perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version posted August 7, 2020. perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version posted August 7, 2020. . 

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Clinical Characteristics of Patients Who Died of 192 Coronavirus Disease 2019 in China

COVID-19: Gastrointestinal Manifestations and Potential Fecal-Oral 197 Transmission

Fecal specimen diagnosis 2019 novel coronavirus-infected 199 pneumonia

A pneumonia outbreak associated 201 with a new coronavirus of probable bat origin

Beware: Gastrointestinal symptoms can be a 205 manifestation of COVID-19

A case of COVID-19 patient with the diarrhea as 207 initial symptom and literature review

Clinical characteristics of 140 209 patients infected with SARS-CoV-2 in Wuhan

Review article: gastrointestinal features in COVID-19 and the 213 possibility of faecal transmission

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preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version