S2467 COVID-19 and Ulcerative Colitis Flare: A Coincidence or Causality?

Abstract

Introduction: The coronavirus pandemic is an ongoing worldwide health crisis and patients with COVID-19 typically present with respiratory symptoms. However, gastrointestinal (GI) symptoms have also been reported in patients diagnosed with this infection and symptoms include diarrhea, nausea and anorexia. In patients with existing GI disease, the presentation and evolution of symptoms should be carefully assessed to establish the most likely cause and the most appropriate course of action. We report a case of a patient with Ulcerative Colitis (UC) in remission for more than a decade who presented with COVID-19 and GI symptoms, raising the question if a UC flare was mimicking COVID-19 or if the viral infection resulted in the culprit that led to a flare. Case Description/Methods: Case of a 77 y/o man with past medical history of colon adenocarcinoma s/p right hemicolectomy in 2009, DM Type 2, HTN, and UC diagnosed in 2009 in remission since 2010. This patient presented to the hospital initially with complaints of 3-4 episodes of watery diarrhea for one week. COVID-19 test was positive; however, patient did not present additional symptoms for which was enrolled in a home quarantine program. One month after initial diagnosis of COVID-19 patient continued with persistent diarrhea which evolved to bloody diarrheas and he was admitted to the hospital with volume depletion and acute kidney injury. Laboratories showed leukocytosis, normocytic anemia, and elevated CRP and fecal calprotectin. Abd/pelvic CT scan was remarkable for pancolitis. Physical exam was remarkable for dry oral mucosa and left lower quadrant abdominal pain on palpation. Due to persistent diarrhea and previous history of IBD a sigmoidoscopy was done which was consistent with an UC flare. Patient was started on steroids and infliximab. He continued with infliximab infusions without complications and with resolution of diarrhea. Discussion: Patients with COVID-19 are at risk for developing GI complications and in patients with existing IBD it is important to monitor duration of GI symptoms and presentation, as COVID-19 can mimic an IBD. Some studies have confirmed that duration of diarrhea in COVID-19 patients vary from 1-14 days. The initial presentation of this patient with more than 10 years of remission was suggestive of GI manifestations due to COVID-19 infection, however the persistence of symptoms led us to suspect an IBD flare which was confirmed with direct colonic visualization followed by prompt treatment and management.