A fatal case of COVID-19 pneumonia occurring in a patient with severe acute ulcerative colitis

Mazza, Stefano; Sorce, Andrea; Peyvandi, Flora; Vecchi, Maurizio; Caprioli, Flavio

doi:10.1136/gutjnl-2020-321183

Cited by 65 publications

(60 citation statements)

References 8 publications

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“…7 The third study reported a single case of COVID-19 occurring in an adult patient with UC. 9 The fourth study reported eight children with IBD who had mild SARS- Regarding outcomes, the high case fatality rate in our cohort was not significantly different from that of the general population in the region. We consider that both rates were highly biased by the inclusion of more serious cases, while asymptomatic or mild cases remained isolated at home without testing for infection.…”

Section: Discussionmentioning

confidence: 47%

2019 novel coronavirus disease (COVID‐19) in patients with inflammatory bowel diseases

Taxonera

Sagastagoitia

Alba

et al. 2020

Aliment Pharmacol Ther

164

188

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Background: Data on patients with inflammatory bowel diseases (IBD) who have had 2019 novel coronavirus (SARS-CoV-2) disease (COVID-19) are needed.Aim: To report the clinical characteristics, including gastrointestinal symptoms, of COVID-19 in IBD patients, and to assess the risk of COVID-19 in IBD. Methods:This case series included consecutive IBD patients with laboratory-confirmed COVID-19. Age-adjusted cumulative incidences were compared with the general population in the Madrid region.Results: Through April 8, 12 of 1918 IBD patients were diagnosed with COVID-19. The average age was 52 years, 75% of the patients were female and 58.3% had Crohn's disease. Seven patients (58%) were on maintenance treatment with immunomodulators/biologics, of these four with combined therapy (33%). Eight patients (66%) required hospitalisation (one intensive care unit admission, and two deaths), and four patients were isolated at home. Nine patients had diarrhoea ranging between 4 and 10 loose stools per day (mean 5.4, SD 1.6). In five patients (42%) diarrhoea was a presenting symptom. In two patients, diarrhoea was the only symptom at debut. Cumulative incidence of COVID-19 was 6.2 per 1000 IBD patients. IBD patients had a lower adjusted incidence ratio of COVID-19 (OR 0.74, 95% CI 0.70-0.77; P < 0.001), and a similar associated mortality ratio (OR 0.95, 95% CI: 0.84-1.06; P = 0.36), compared with the general population.Conclusions: IBD patients do not have an increased risk of COVID-19 and associated mortality compared with the general population. In many IBD patients, diarrhoea was a presenting symptom, and sometimes, was the only symptom at onset of COVID-19. IMM treatment, n (%) 559 (29.1) Azathioprine, n (%) 353 (63.1) Mercaptopurine, n (%) 105 (18.8) Methotrexate, n (%) 90 (16.1) Tofacitinib*, n (%) 6 (1.1) Tacrolimus, n (%) 2 (0.3) Mycophenolate, n (%) 3 (0.5) Biological treatment, n (%) 301 (15.7) Infliximab, n (%) 110 (36.5) Adalimumab, n (%) 119 (39.5) Golimumab, n (%) 31 (10.3) Vedolizumab, n (%) 18 (6.0) Ustekinumab, n (%) 23 (7.6) Biological + IMM treatment, n (%) 157 (8.2) IMM alone, n (%) 402 (20.9) Biologics alone n (%) 144 (7.5) Disease location (L): L1 terminal ileum, L2 colon, L3 ileocolon, L4 upper gastrointestinal tract; Disease behaviour (B): B1 nonstricturing nonpenetrating; B2 stricturing, B3 penetrating. IMM: immunomodulator; Tofacitinib* is a JAKinase inhibitor not similar to conventional IMM. Abbreviations: IQR, interquartile range; Montreal classification' of Crohn's disease (CD); SD, standard deviation; UC, ulcerative colitis.

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Section: Discussionmentioning

confidence: 47%

2019 novel coronavirus disease (COVID‐19) in patients with inflammatory bowel diseases

Taxonera

Sagastagoitia

Alba

et al. 2020

Aliment Pharmacol Ther

164

188

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“…Severe active disease requiring the use of steroids, especially in elderly patients, could be associated with worse outcomes, as recently reported. 11 This finding highlights the need to continue effective maintenance therapy in order to avoid severe IBD flares, which would require hospital visits for testing or admission. Since hospitals may be the place with the highest risk of infection as long as the pandemic lasts, there is a consequent need to restructure IBD care and to replace hospital visits with virtual clinics and remote monitoring, [20][21][22] whenever possible.…”

Section: Discussionmentioning

confidence: 98%

“…The first reports of COVID-19 in patients with IBD with fatal outcomes are starting to emerge. 11 So far, the risk, presentation and severity of coronavirus infection in patients with IBD have not been studied. This study aimed to describe how COVID-19 presents and evolves in patients with IBD, and to identify risk factors that predict the severity and outcomes of COVID-19 in patients with IBD.…”

Section: Significance Of This Studymentioning

confidence: 99%

Outcomes of COVID-19 in 79 patients with IBD in Italy: an IG-IBD study

Bezzio¹,

Saibeni²,

Variola

et al. 2020

Gut

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299

366

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ObjectivesCOVID-19 has rapidly become a major health emergency worldwide. Patients with IBD are at increased risk of infection, especially when they have active disease and are taking immunosuppressive therapy. The characteristics and outcomes of COVID-19 in patients with IBD remain unclear.DesignThis Italian prospective observational cohort study enrolled consecutive patients with an established IBD diagnosis and confirmed COVID-19. Data regarding age, sex, IBD (type, treatments and clinical activity), other comorbidities (Charlson Comorbidity Index (CCI)), signs and symptoms of COVID-19 and therapies were compared with COVID-19 outcomes (pneumonia, hospitalisation, respiratory therapy and death).ResultsBetween 11 and 29 March 2020, 79 patients with IBD with COVID-19 were enrolled at 24 IBD referral units. Thirty-six patients had COVID-19-related pneumonia (46%), 22 (28%) were hospitalised, 7 (9%) required non-mechanical ventilation, 9 (11%) required continuous positive airway pressure therapy, 2 (3%) had endotracheal intubation and 6 (8%) died. Four patients (6%) were diagnosed with COVID-19 while they were being hospitalised for a severe flare of IBD. Age over 65 years (p=0.03), UC diagnosis (p=0.03), IBD activity (p=0.003) and a CCI score >1 (p=0.04) were significantly associated with COVID-19 pneumonia, whereas concomitant IBD treatments were not. Age over 65 years (p=0.002), active IBD (p=0.02) and higher CCI score were significantly associated with COVID-19-related death.ConclusionsActive IBD, old age and comorbidities were associated with a negative COVID-19 outcome, whereas IBD treatments were not. Preventing acute IBD flares may avoid fatal COVID-19 in patients with IBD. Further research is needed.

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“…5 In GUT several articles report on GI symptoms, detection of the virus in faeces and potential pathophysiological aspects including viral receptor expression in the GI tract. [6][7][8][9][10][11][12] Two large clinical studies from China focused on GI symptoms and detection of the virus in faeces. 6 7 Jin et al investigated 74 patients infected with SARS-CoV-2 with GI symptoms such as diarrhoea, nausea and vomiting.…”

mentioning

confidence: 99%

“…In this issue of GUT, death was reported in an elderly patient with severe acute ulcerative colitis (on mesalazine) who was treated with high dose intravenous corticosteroids and subsequently developed COVID-19 pneumonia. 12 Further evidence is required to define the best treatment strategy in patients with IBD especially those with active disease.…”

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confidence: 99%