From the Department of Pathology, University of Michigan, Ann Arbor (Westerhoff, Hrycaj, Chan, Pantanowitz, Choi, Greenson, Lamps).
The Department of Pathology, The Ohio State University Wexner Medical Center, Columbus (Jones, Tu).
Arch Pathol Lab Med. 2021 Sep 1;145(9):1062-1068. doi: 10.5858/arpa.2021-0137-SA.
CONTEXT.—: Although primarily considered a respiratory illness, coronavirus disease 2019 (COVID-19) can cause gastrointestinal manifestations.
OBJECTIVE.—: To evaluate histopathology and in situ hybridization for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in gastrointestinal samples from patients with recent and remote COVID-19.
DESIGN.—: Patients with positive SARS-CoV-2 nasopharyngeal tests and a gastrointestinal tissue specimen were included. SARS-CoV-2 in situ hybridization (ISH) was performed on each sample. A subset had SARS-CoV-2 next-generation sequencing (NGS) performed.
RESULTS.—: Twenty-five patients met inclusion criteria. Five had positive SARS-CoV-2 nasopharyngeal tests within 7 days of their gastrointestinal procedure. Two were ulcerative colitis patients on steroid therapy who lacked typical COVID-19 symptoms. Their colectomies showed severe ulcerative colitis; one demonstrated SARS-CoV-2 by NGS but a negative ISH. Another had an ischemic colon resected as a complication of the COVID-19 course; however, both ISH and NGS were negative. A fourth had a normal-appearing terminal ileum but positive ISH and NGS. The fifth patient had ileal ulcers with SARS-CoV-2 negativity by both modalities. The remaining 20 patients had positive nasopharyngeal tests an average of 53 days prior to procedure. None of their samples demonstrated SARS-CoV-2 ISH positivity, but one was positive on NGS despite a negative nasopharyngeal test.
CONCLUSIONS.—: Gastrointestinal findings from SARS-CoV-2-infected patients ranged from normal with virus detected by ISH and NGS to bowel ischemia secondary to systemic viral effects without evidence of virus in the tissue. No distinct histologic finding was identified in those with gastrointestinal tissue specimens demonstrating SARS-CoV-2 positivity in this cohort.
虽然新型冠状病毒病 2019（COVID-19）主要被认为是一种呼吸道疾病，但它可引起胃肠道表现。
评估近期和远期 COVID-19 患者胃肠道样本中严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）的组织病理学和原位杂交。
纳入 SARS-CoV-2 鼻咽拭子检测阳性且有胃肠道组织标本的患者。对每个样本进行 SARS-CoV-2 原位杂交（ISH）。部分患者进行了 SARS-CoV-2 下一代测序（NGS）。
25 例患者符合纳入标准。5 例患者在胃肠道操作前 7 天内 SARS-CoV-2 鼻咽拭子检测阳性。其中 2 例为正在接受类固醇治疗的溃疡性结肠炎患者，缺乏典型的 COVID-19 症状。他们的结肠切除术显示严重的溃疡性结肠炎；1 例通过 NGS 检测到 SARS-CoV-2，但 ISH 为阴性。另 1 例因 COVID-19 病程而发生缺血性结肠炎，需要结肠切除术，但 ISH 和 NGS 均为阴性。第 4 例患者末端回肠外观正常，但 ISH 和 NGS 均为阳性。第 5 例患者回肠溃疡，两种方法均为 SARS-CoV-2 阴性。其余 20 例患者在操作前平均 SARS-CoV-2 鼻咽拭子检测阳性 53 天。他们的样本均未显示 SARS-CoV-2 ISH 阳性，但 1 例尽管鼻咽拭子检测阴性，但 NGS 为阳性。
从 SARS-CoV-2 感染患者的胃肠道表现范围从组织学正常但通过 ISH 和 NGS 检测到病毒到因全身病毒作用导致的肠缺血而无组织内病毒证据不等。在本队列中，胃肠道组织标本中检测到 SARS-CoV-2 阳性的患者中未发现明显的组织学发现。
