Korean J Gastroenterol.  2023 Apr;81(4):163-167. 10.4166/kjg.2022.144.

Two Case Reports of Newly Diagnosed Crohn’s Disease after COVID-19 in Pediatric Patients

• Kim K
• Kim Sy
• Kim YE
• Kwon KW
• Han EM
• Kim A

• KMID: 2541778
• DOI: http://doi.org/10.4166/kjg.2022.144

Abstract

Since the coronavirus disease 2019 (COVID-19) outbreak caused by the severe acute respiratory syndrome-coronavirus-2 virus (SARS-CoV-2), various complications have been reported. Although most COVID-19 cases exhibited flu-like symptoms, COVID-19 may dysregulate the immune response and promote overwhelming levels of inflammation in some patients. Inflammatory bowel disease (IBD) is caused by dysregulated or inappropriate immune responses to environmental factors in a genetically susceptible host, and a SARS-CoV-2 infection may act as a possible cause of IBD. This paper describes two pediatric patients who developed Crohn’s disease following a SARS-CoV-2 infection. They were previously healthy before the SARS-CoV-2 infection. On the other hand, they started to develop fever and gastrointestinal symptoms several weeks after recovery from the infection. They were diagnosed with Crohn’s disease by imaging and endoscopic studies, and their symptoms improved after treatment with steroids and azathioprine. This paper suggests that a SARS-CoV-2 infection may trigger IBD in predisposed patients.

Keyword

COVID-19; SARS-CoV-2; Inflammatory bowel disease; Crohn disease; Pediatric multisystem inflammatory disease

Figure

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  Fig. 1 Magnetic resonance enterography shows segmental wall thickening of the distal ileum with some deep mucosal enhancement. (yellow arrows).

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  Fig. 2 Esophagogastroduodenoscopy shows a few small ulcers in the distal esophagus (A), and ileocolonoscopy shows edematous mucosa with multiple erosions, prominent lymphoid follicles in the terminal ileum (B), and a small ulcer in the ascending colon (C).

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  Fig. 3 Microscopic finding of the terminal ileum shows an ill-defined granuloma with multinucleated giant cells and no necrosis associated with chronic inflammatory cells (H&E, ×100).

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  Fig. 4 Abdominal computed tomography shows wall thickening of the terminal ileum (blue arrow).

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  Fig. 5 Ileocolonoscopy shows ileocecal valve deformity with mucosal edema and ulcerations (A) and a large ulcer with cobblestone appearance in the cecum (B).

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  Fig. 6 Microscopic finding of the transverse colon shows a small erosion associated with inflammatory cell infiltration (aphthous ulcer) and fissure formation (H&E, x100).

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