Although COVID-19 clinical manifestations are mostly respiratory gastrointestinal manifestations may also be encountered in some instances. However, at the time of our writing, little is known about COVID-19, associated pathologic changes in the digestive system. We describe a case of COVID-19 disease with digestive manifestations that demonstrated specific pathologic changes in the gastrointestinal tract. Histological examination of endoscopic biopsy samples from duodenum was performed in combination with a review of the literature. According to our literature review, digestive histopathologic changes have been reported in 14 cases of COVID-19 patients. Pathological findings were generally nonspecific in all these cases and ranged from epithelial damage, lymphoplasmacytic and macrophages infiltrates, prominent endothelitis and ischemic enterocolitis. In our patient, histological features were more specific, characterized by several viral cytopathic effects associated with mucosal damage, numerous microthrombi and positive staining of ACE2 on various enterocytes. Histological analysis is not a practical option for the diagnosis of SARS-CoV-2 infections but could help to elucidate pathophysiology of the disease. Those changes may be specific in the GI tract and related clinical manifestations should not be overlooked. Furthermore, preventive measures for oral-fecal transmission should not be minimized.
References
[1]
Polak, S.B., Van Gool, I.C., Cohen, D., Jan, H. and van Paassen, J. (2020) A Systematic Review of Pathological Findings in COVID-19: A Pathophysiological Timeline and Possible Mechanisms of Disease Progression. Modern Pathology, 33, 2128-2138. https://doi.org/10.1038/s41379-020-0603-3
[2]
Vasquez-Bonilla, W.O., Orozco, R., Argueta, V., et al. (2020) A Review of the Main Histopathological Findings in the Coronavirus Disease 2019 (COVID-19). Human Pathology, 105, 74-83. https://doi.org/10.1016/j.humpath.2020.07.023
[3]
Zhang, H., Penninger, J.M., Li, Y., Zhong, N. and Slutsky, A.S. (2020) Angiotensin-Converting Enzyme 2 (ACE2) as a SARS-CoV-2 Receptor: Molecular Mechanisms and Potential Therapeutic Target. Intensive Care Medicine, 46, 586-590. https://doi.org/10.1007/s00134-020-05985-9
[4]
Luo, S., Zhang, X. and Xu, H. (2020) Don’t Overlook Digestive Symptoms in Patients with 2019 Novel Coronavirus Disease (COVID-19). Clinical Gastroenterology and Hepatology, 18, Article No. 1636. https://doi.org/10.1016/j.cgh.2020.03.043
[5]
Han, C., Duan, C., Zhang, S., et al. (2020) Digestive Symptoms in COVID-19 Patients with Mild Disease Severity: Clinical Presentation, Stool Viral RNA Testing, and Outcomes. The American Journal of Gastroenterology, 115, 916-923. https://doi.org/10.14309/ajg.0000000000000664
[6]
McNabb-Baltar, J., Jin, D.X., Grover, A.S., et al. (2020) Lipase Elevation in Patients with COVID-19. The American Journal of Gastroenterology, 115, 1286-1288. https://doi.org/10.14309/ajg.0000000000000732
[7]
Tian, Y., Rong, L., Nian, W. and He, Y. (2020) Gastrointestinal Features in COVID-19 and the Possibility of Faecal Transmission. Alimentary Pharmacology & Therapeutics, 51, 843-851. https://doi.org/10.1111/apt.15731
[8]
Pedro-Botet, J. and Climent, E. (2020) The Forgotten Gastrointestinal Tract in COVID-19 Infection. Clinical and Translational Gastroenterology, 11, e00216. https://doi.org/10.14309/ctg.0000000000000216
[9]
Xiao, F., Tang, M., Zheng, X., Liu, Y., Li, X. and Shan, H. (2020) Evidence for Gastrointestinal Infection of SARS-CoV-2. Gastroenterology, 158, 1831-1833. https://doi.org/10.1053/j.gastro.2020.02.055
[10]
Al Nemer, A. (2020) Histopathologic and Autopsy Findings in Patients Diagnosed with Coronavirus Disease 2019 (COVID 19): What We Know so Far Based on Correlation with Clinical, Morphologic and Pathobiological Aspects. Advances in Anatomic Pathology, 27, 363-370. https://doi.org/10.1097/PAP.0000000000000276
[11]
Varga, Z., Flammer, A.J., Steiger, P., et al. (2020) Endothelial Cell Infection and Endotheliitis in COVID-19. The Lancet, 395, 1417-1418. https://doi.org/10.1016/S0140-6736(20)30937-5
[12]
Talmon, G.A. (2010) Histologic Features of Cytomegalovirus Enteritis in Small Bowel Allografts. Transplantation Proceedings, 42, 2671-2675. https://doi.org/10.1016/j.transproceed.2010.04.059
[13]
Cho, M., Liu, W., Balzora, S., Suarez, Y., et al. (2020) Clinical and Intestinal Histopathological Findings in SARS-CoV-2/COVID-19 Patients with Hematochezia. https://doi.org/10.1101/2020.07.29.20164558
[14]
Xiaohong Y, Tingyuan L and Zhicheng H. (2020) Coronavirus Disease Pneumonia 2019 (COVID-19): 3 Cases of Puncture Histopathology in Several Locations. Chinese Journal of Pathology, 49, 411-417.
[15]
Wichmann, D., Sperhake, J.P., Lütgehetmann, M., et al. (2020) Autopsy Findings and Venous Thromboembolism in Patients with COVID-19: A Prospective Cohort Study. Annals of Internal Medicine, 173, 268-277. https://doi.org/10.7326/L20-1206
[16]
Qian, Q., Fan, L., Liu, W., Li, J., Yue, J., et al. (2020) Direct Evidence of Active SARS-CoV-2 Replication in the Intestine. Clinical Infectious Diseases, 73, 361-366. https://doi.org/10.1093/cid/ciaa925
[17]
Jordan, R.E., Adab, P. and Cheng, K.K. (2020) Covid-19: Risk Factors for Severe Disease and Death. BMJ, 368, m1198.
[18]
Cascella, M., Rajnik, M., Cuomo, A., Dulebohn, S.C. and Di Napoli, R. (2020) Features, Evaluation and Treatment Coronavirus (COVID-19). StatPearls Publishing.
[19]
Dong, L., Hu, S. and Gao, J. (2020) Discovering Drugs to Treat Coronavirus Disease 2019 (COVID-19). Drug Discoveries & Therapeutics, 14, 58-60. https://doi.org/10.5582/ddt.2020.01012
