Inflammatory Bowel Disease Presenting With Concurrent COVID-19 Multisystem Inflammatory Syndrome

Abstract

Coronavirus disease 2019 is associated with a postinfectious multisystem inflammatory syndrome in children (MIS-C). This syndrome is marked by cytokine storm and multiorgan dysfunction, often affecting the gastrointestinal tract, the heart, and the hematopoietic system. We describe the case of a 16-year-old boy with an initial presentation of severe inflammatory bowel disease and concurrent MIS-C. He presented with abdominal pain, diarrhea, and hematochezia and met criteria for the systemic inflammatory response syndrome. Laboratory inflammatory profiling revealed markedly elevated ferritin, D-dimer, C-reactive protein, soluble interleukin 2, and interleukin 6 levels. Endoscopy and colonoscopy revealed severe active gastroduodenitis, patchy colitis, and a normal-appearing terminal ileum. The patient was treated with a combination of steroids, intravenous immunoglobulin, and infliximab, and his symptoms slowly resolved over a 3-week period. In this case, we describe coincident MIS-C with a remarkably severe and difficult-to-treat initial presentation of inflammatory bowel disease and highlight the need to investigate the effect of coronavirus disease 2019 and MIS-C on inflammatory disorders.

Mechanisms underlying genetic susceptibility to multisystem inflammatory syndrome in children (MIS-C)

“…Patient 2 is a 16-year-old male whose clinical course has been recently described. 12 He was healthy until 3 weeks before admission, when he developed hematochezia. He had neutrophilia, CD4 1 and CD8 1 T-cell lymphopenia, procalcitonin and C-reactive protein levels exceeding the upper normal limits by 100-and 30-fold, a mild coagulopathy, and a positive result of IgG testing for SARS-CoV-2 (Table II).…”

Is It Inflammatory Bowel Disease Flare or Pediatric Inflammatory Multisystem Syndrome Temporally Associated with COVID-19?

“…Although our knowledge about PIMS-TS/MIS-C is expanding, little is known about the risk factors, clinical course, treatment strategies, and outcomes of PIMS-TS/MIS-C in children with underlying chronic inflammatory conditions. Until now, there have been several case reports regarding the occurrence of PIMS-TS/MIS-C in children with underlying IBD [ 22 , 23 , 24 , 25 ].…”

“…Sweeny et al [ 24 ] described a case of a 16-year-old boy with a new-onset Crohn’s disease and overlapping features of PIMS-TS/MIS-C. His initial symptoms included progressive bloody diarrhea and abdominal pain which were preceded by mild rhinorrhea two weeks earlier [ 24 ]. On admission, the patient was febrile and tachycardic.…”

“…On admission, the patient was febrile and tachycardic. His laboratory results revealed elevation of inflammatory markers, anemia, hyperferritinemia, and elevation of D-dimers [ 24 ]. In gastroscopy, features of severe gastritis and duodenitis were seen.…”

“…In gastroscopy, features of severe gastritis and duodenitis were seen. Interestingly, in duodenal biopsies, there were features of submucosal vasculitis [ 24 ]. Colonoscopy showed patchy moderate to severe colitis, confirmed in histopathological evaluation [ 24 ].…”