COVID-19 induced mesenteric ischemia in a patient with ulcerative colitis and paroxysmal nocturnal haemoglobinuria despite thromboprophylaxis

Abstract

Inflammatory bowel disease and paroxysmal nocturnal hemoglobinuria (PNH) are both well-known prothrombotic states. However, ongoing thromboprophylaxis is usually effective in such conditions. However, we report about an imbalance that was triggered by like SARS-CoV-2 infection. There is evidence that SARS-CoV-2 infection leads to thrombosis of vessels. The thrombosis of mesenteric vessels can be multifocal and without respiratory symptoms and leads to devastating consequences like resection of large segments of the bowel and lifelong requirement of parenteral nutritional support. We report about a case of ulcerative colitis (in remission) and PNH where COVID-19 resulted in mesenteric ischemia.

Alternative aetiologies must be ruled out before one makes COVID-19 responsible for mesenteric vein thrombosis

“… 2 Second, the patient suffered from PNH. 1 As already mentioned by the authors, several cases of mesenteric and portal vein thrombosis associated with PNH have been reported. 3 Third, no evidence was presented that SARS-CoV-2 was symptomatic or had triggered an inflammatory response.…”

“…Josef Finsterer 1 and Sounira Mehri 2 1 Neurology and Neurophysiology Center, Vienna, Austria 2 Biochemistry Laboratory, LR12ES05 "Nutrition-Functional Foods and Vascular Health", Faculty of Medicine, Monastir, Tunisia…”

“…We read with interest the article by Choudhury et al on a 47-year-old female with ulcerative colitis, portal cavernomas cholangiopathy and paroxysmal nocturnal haemoglobinuria (PNH) who presented with mesenteric ischemia attributed to acute SARS-CoV-2 infection. 1 The report is excellent but has limitations that raise objections that should be discussed.…”

“…Dehydration or exsiccosis as a cause of mesenteric vein thrombosis must also be ruled out. Since the patient was on long-term treatment with danazol (200 mg/day) 1 and danazol is known to cause thrombosis, 4 it is conceivable that this drug contributed to the index patient’s risk of thrombosis.…”