S3476 SARS-CoV-2 Infection in a Patient With Crohn’s Disease Currently on Infliximab Therapy: A Case Report

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INTRODUCTION: Disease severity of SARS-CoV-2 is correlated with patient age and comorbidities. One population initially thought to be at increased risk of infection are patients with Inflammatory Bowel Disease (IBD). Understanding how this population is affected by SARS-CoV-2 is necessary for effective detection and management. We present the case of COVID-19 in a young Crohn’s disease patient on Infliximab. CASE DESCRIPTION/METHODS: A 24-year-old female with Crohn’s disease on Infliximab presented febrile with anosmia on 3/11. Five days later she developed myalgias, chest pain, coughing, and sneezing. She denied fever, dyspnea and GI upset. Presumed to be seasonal allergies, she was instructed to monitor symptoms. On 3/27, she developed a fever of 99.5 deg F. COVID-19 testing was performed and returned positive on 3/30. She completed 14-day quarantine with symptom resolution on 4/7, unremarkable lab work and chest X-ray with no signs of pneumonia. However, on 4/20, she had recurrence of symptoms, including worsening dyspnea and chest pain. Telehealth visit the next day revealed resting O2 sat of 98%, 6 minute walking desaturation test with O2 sat of 96% and heart rate of 119 bpm. The patient also reported coughing and increasing dyspnea. Two minutes later, heart rate normalized to 82 bpm and O2 sat was 97%. The patient was followed by a dedicated COVID-19 clinic until complete symptom resolution. DISCUSSION: In this case, our patient presented febrile with dyspnea five days after her Infliximab infusion. Current literature suggests IBD patients on immunotherapy are not at higher risk of contracting COVID-19 [1]. Also, many reports link symptoms of nausea, vomiting, and diarrhea with this infection. In a recent case report, an elderly woman with Ulcerative Colitis had initially presented with signs of IBD flare, instead of typical URI symptoms, which unfortunately resulted in misdiagnosis and her fatality [2]. Our patient did not exhibit GI distress. Lastly, she had symptom resurgence after 12 days of being asymptomatic, which has yet to be described in an IBD patient. Considering the complexity of this coronavirus, more information is needed to understand varying manifestations and its implications in IBD patients.