S3620 New Diagnosis of Crohn’s Disease After COVID-19

Abstract

Introduction: Coronavirus disease 2019 (COVID-19) dysregulates the immune response and promotes overwhelming levels of inflammation. Data is scarce on the consequent effects of COVID-19 on the immune system and whether patients with COVID-19 are more prone to developing inflammatory bowel disease (IBD). We report two cases of previously healthy patients with a family history of IBD and recent COVID-19 diagnoses who were subsequently diagnosed with Crohn's disease. Case Description/Methods: Case 1: A previously healthy 17-year-old female presented with fever, bloody diarrhea, and weight loss. The patient had a diagnosis of COVID-19 from one month prior and a family history of Crohn's disease in her father. She underwent colonoscopy, which revealed ulcerations in terminal ileum and throughout the colon. Pathology demonstrated acute and chronic inflammation as well as chronic post-inflammatory changes throughout the colon and terminal ileum. She was diagnosed with Crohn's ileocolitis and treated with steroids followed by infliximab with a good clinical response. Case 2: A previously healthy 19-year-old male presented with recurrent abdominal pain and non-bloody diarrhea of two months. The patient had numerous first-degree relatives with Crohn's disease and a recent diagnosis of COVID-19 six months prior. Subsequent colonoscopy demonstrated a terminal ileum stricture with scarring and denuded mucosa. Pathology illustrated markedly active chronic ileitis. Magnetic resonance enterography (MRE) showed small bowel obstruction related to a long segment of active inflammation and stricturing within the terminal ileum. The patient was diagnosed with Crohn's disease and treated with steroids followed by adalimumab with marked improvement. Discussion: In our two cases, both patients were previously healthy aside from a recent COVID-19, and both had family history of Crohn's disease. IBD is thought to develop in patients with a genetic predisposition whose immune systems encounter an environmental trigger that promotes the inappropriate inflammation to normal intestine. New infections have been implicated as possible trigger events culminating in the pathogenesis seen in IBD. COVID-19 may represent one type of infection that drives new IBD development, especially given its known dysregulatory effects on the immune system. Whether our patients' new diagnoses of Crohn's disease were related to their recent COVID-19 infection remains unclear, and large epidemiological studies are required to investigate further.