Case Report: A Peculiar Case of Inflammatory Colitis After SARS-CoV-2 Infection

Abstract

We report a case of inflammatory colitis after SARS-CoV-2 infection in a patient with no additional co-morbidity who died within three weeks of hospitalization. As it is becoming increasingly clear that SARS-CoV-2 infection can cause immunological alterations, we investigated the expression of the inhibitory checkpoint PD-1 and its ligand PD-L1 to explore the potential role of this axis in the break of self-tolerance. The presence of the SARS-CoV-2 virus in colon tissue was demonstrated by qRT-PCR and immunohistochemical localization of the nucleocapsid protein. Expression of lymphocyte markers, PD-1, and PD-L1 in colon tissue was investigated by IHC. SARS-CoV-2-immunoreactive cells were detected both in the ulcerated and non-ulcerated mucosal areas. Compared to healthy tissue, where PD-1 is weakly expressed and PD-L1 is absent, PD-1 and PD-L1 expression appears in the inflamed mucosal tissue, as expected, but was mainly confined to non-ulcerative areas. At the same time, these markers were virtually undetectable in areas of mucosal ulceration. Our data show an alteration of the PD-1/PD-L1 axis and suggest a link between SARS-CoV-2 infection and an aberrant autoinflammatory response due to concomitant breakdown of the PD-1/PD-L1 interaction leading to early death of the patient.

A New Onset of Ulcerative Colitis Post-COVID-19: A Case Report

“…The patient's age ranges between 19 and 84. Three were female cases [ 11 - 13 ], and seven were male cases [ 14 - 19 ]. Our case involved a 21-year-old male patient.…”

Colitis After SARS-CoV-2 Infection

“…There has been a case of severe ulcerative colitis after COVID-19 which was fatal, in this case, SARS-CoV-2 infection was thought to trigger changes in immunomodulatory pathways [ 8 ]. Further studies on the gastrointestinal sequelae of COVID-19 are important to create strategies that would manage, treat, or prevent complications.…”

The Spectrum of Digestive Tract Histopathologic Findings in the Setting of Severe Acute Respiratory Syndrome Coronavirus-2 Infection: What Pathologists Need to Know

“…31 Gross findings include dilation of the colon with some thickening of the wall, hemorrhagic-dusky necrotic appearance of the serosal surface, petechiae, fibrinous exudates, occasional perforations, and air bubbles. 31,36,[45][46][47] Mucosal alterations included edema, patchy petechiae and erythema, occasional bleeding, focal loss of mucosal folds, erosions and areas of ulceration, areas of necrosis with dark-brown discoloration, and fibrinous exudates. 14,31,32,48,49 In about 18.5% of studied cases of ischemic colitis, a colonoscopic examination was essentially normal.…”

“…14,27,29,31,32,36,[45][46][47][48][50][51][52] SARS-CoV-2 has been detected in some cases of ischemic colitis as a cytoplasmic dot-like staining pattern in the surface and crypt epithelial cells as well as in the LP cells of both inflamed and noninflamed colonic mucosa. 14,36,46,47,50 Features suggestive of vascular injury of the colon due to SARS-CoV-2 have been described, including prominent multifocal small and medium-sized vasculitis of the submucosal vessels with bizarre-appearing endothelial cells, luminal obliteration, early thrombi formation, and bleeding into vessel walls. These observations have been confirmed through the detection of SARS-CoV-2 in the cytoplasm of the injured endothelial cells.…”