Extensive mucosal sloughing of the small intestine and colon in a patient with severe COVID-19

Tsukasa Yamakawa; Keisuke Ishigami; Ayumu Takizawa; Yumemi Takada; Sae Ohwada; Yoshihiro Yokoyama; Tomoe Kazama; Daisuke Hirayama; Shinji Yoshii; Hiro-O Yamano; Rina Ohizumi; Naofumi Bunya; Taro Sugawara; Mitsuhiro Tsujiwaki; Shintaro Sugita; Satoshi Takahashi; Eichi Narimatsu; Hiroshi Nakase

doi:10.1002/deo2.42

Extensive mucosal sloughing of the small intestine and colon in a patient with severe COVID-19

DEN Open. 2022 Apr;2(1):e42. doi: 10.1002/deo2.42. Epub 2021 Sep 7.

Authors

Tsukasa Yamakawa¹, Keisuke Ishigami¹, Ayumu Takizawa¹, Yumemi Takada¹, Sae Ohwada¹, Yoshihiro Yokoyama¹, Tomoe Kazama¹, Daisuke Hirayama¹, Shinji Yoshii¹, Hiro-O Yamano¹, Rina Ohizumi², Naofumi Bunya², Taro Sugawara³, Mitsuhiro Tsujiwaki³, Shintaro Sugita³, Satoshi Takahashi⁴, Eichi Narimatsu², Hiroshi Nakase¹

Affiliations

¹ Department of Gastroenterology and Hepatology Sapporo Medical University Hokkaido Japan.
² Department of Emergency Medicine Sapporo Medical University Hokkaido Japan.
³ Department of Surgical Pathology Sapporo Medical University Hokkaido Japan.
⁴ Department of Infection Control and Laboratory Medicine Sapporo Medical University Hokkaido Japan.

PMID: 35079746
PMCID: PMC8646689
DOI: 10.1002/deo2.42

Abstract

Patients with coronavirus disease 2019 (COVID-19) primarily cause respiratory symptoms. However, gastrointestinal (GI) symptoms can also occur. The endoscopic characteristics of the GI tract in COVID-19 patients remain unclear. We herein report a 62-year-old male with severe COVID-19 who needed multidisciplinary treatment, including extracorporeal membrane oxygenation (ECMO). Despite the improvement in his respiratory status, GI bleeding developed. Capsule endoscopy and colonoscopy revealed extensive mucosal sloughing in the lower intestinal tract. Additionally, we performed a comprehensive analysis of the mRNA expression levels of various proinflammatory cytokines in the intestinal mucosal tissues. The results suggested a significant elevation of IL-6, which could be involved in the pathophysiology of the GI involvement in COVID-19. Further investigation with more clinical data, including endoscopic findings and molecular analyses, will contribute to a comprehensive understanding of COVID-19-associated GI injury.

Keywords: COVID‐19; capsule endoscopy; mucosal sloughing.

Publication types

Case Reports