A Challenging Colectomy for Acute Severe Ulcerative Colitis Complicated by COVID-19

Abstract

We present the case of a patient with acute severe ulcerative colitis and concomitant COVID-19-related pneumonia who required a colectomy after a prolonged and complicated hospitalization during the initial stages of the SARS-CoV-2 pandemic, before the establishment of official procedures.

Systematic Review on Inflammatory Bowel Disease Patients With Coronavirus Disease 2019: It Is Time to Take Stock

“…Finally, 23 studies 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 were included in our systematic review. Most studies were case reports (12 [52.2%]), 16 , 18 , 19 , 22 , 27 , 29 , 32 , 33 , 34 , 35 , 36 , 38 followed by observational cohort studies (3 prospective [13.0%] 17 , 21 , 25 and 6 retrospective studies [26.1%] 20 , 24 , 26 , 28 , 31 , 37 ) and case series (2 [8.7%]) 23 , 30 ( Tables 1 and 2 ). Most studies were of moderate quality according to the NOS score (15 [65.2%]), 16 , 19 , 20 , 22 , 26 , 27 , 28 , 30 , 31 , 38 while the remaining studies were classified as high-quality studies (8 [34.8%]) 17 , 18 , 21 ,…”

“…Elderly patients (>65 y) with COVID-19 were found in 10 studies (43.5%), 16 , 17 , 20 , 23 , 24 , 25 , 26 , 31 , 37 , 38 pediatric cases (<18 y) were reported in 4 studies (17.4%), 21 , 29 , 30 , 36 and an infected pregnant patient was described in 1 case report (4.3%). 27 The ongoing drugs at the time of COVID-19 diagnosis were reported in almost all studies (20 [87.0%]) 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 30 , 32 , 33 , 34 , 35 , 36 , 38 and were as follows: anti–tumor necrosis factor (243 of 790 [30.8%]), mesalamine (203 [25.7%]), thiopurine (83 [10.5%]), vedolizumab (79 [10.0%]), ustekinumab (77 [9.7%]), steroids (68 [8.6%]), combination therapy (biological drug + thiopurine) (59 [7.5%]), other (27 [3.4%]), methotrexate (14 [1.8%]), and tofacitinib (10 [1.3%]). As for COVID-19 symptoms, they were reported in 19 studies (82.6%).…”

“…As for COVID-19 symptoms, they were reported in 19 studies (82.6%). 16 , 17 , 18 , 19 , 20 , 22 , 23 , 24 , 25 , 27 , 29 , 30 , 32 , 33 , 34 , 35 , 36 , 37 , 38 The most frequent symptoms were fever (217 of 449 [48.3%]), cough (209 [46.5%]), and diarrhea (92 [20.5%]), followed by dyspnea (55 [12.2%]), nausea (40 [8.9%]), and abdominal pain (39 [8.7%]) ( Table 4 ).…”

“…The polymerase chain reaction (PCR) analysis of the nasopharyngeal swabs was the most commonly adopted method (17 of 18 [94.4%]). 16 , 17 , 18 , 19 , 20 , 22 , 23 , 25 , 27 , 28 , 31 , 32 , 33 , 34 , 35 , 36 , 38 A chest computed tomography was performed in 7 studies (38.9%). 16 , 19 , 22 , 25 , 32 , 33 , 34 , 35 In 1 study (5.6%), 26 the diagnosis was achieved by laboratory test.…”

“…The treatment of infected subjects was described in 14 articles (60.1%). 16 , 18 , 20 , 21 , 22 , 23 , 27 , 29 , 32 , 33 , 34 , 35 , 36 , 38 The most used drugs were hydroxychloroquine (140 of 586 [23.9%]), lopinavir/ritonavir (48 [8.2%]), steroids (19 [3.2%]), antibiotics (18 [3.1%]), and chloroquine (14 [2.4%]) ( Table 5 ). Importantly, in 3 case reports the patients were treated with infliximab 29 , 33 or tofacitinib.…”