Shorbagi Ali Ibrahim, Obaideen Abdulmunhem, Jundi Majd
Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.
Medical Diagnostic Imaging Department, University Hospital Sharjah, Sharjah, United Arab Emirates.
Front Med (Lausanne). 2023 Mar 16;10:1013125. doi: 10.3389/fmed.2023.1013125. eCollection 2023.
COVID-19 exhibits diverse and systemic clinical symptoms, much like systemic autoimmune diseases, and there are notable similarities in the immune responses seen in both conditions. There are rare reports of ulcerative colitis and autoimmune hepatitis triggered by COVID-19 infection. Reported herein is a case of a previously healthy patient who was diagnosed with chronic colitis resembling ulcerative colitis, autoimmune pancreatitis, and suspected immune-mediated hepatitis (AIH-like hepatitis) 2 months after a COVID-19 infection. A 33-year-old COVID-19-vaccinated male, presented with abdominal pain, nausea, and vomiting for 2 days. He also had bloody diarrhea that persisted for 2 months after recovering from a COVID-19 infection. A diagnosis of acute pancreatitis was confirmed by markedly elevated serum amylase and lipase and a CT scan of the abdomen. Colonoscopy and histopathology findings also confirmed a diagnosis of chronic colitis resembling ulcerative colitis (Mayo Endoscopy Subscore 3). Marked improvement in bloody diarrhea was observed within 72 h of treatment with IV prednisolone. MRI of the abdomen performed due to an unresolved clinical picture of pancreatitis revealed a bulky pancreas showing delayed diffuse homogenous enhancement, findings possibly consistent with autoimmune pancreatitis. Investigation for elevated liver transaminases showed high titers of antinuclear antibodies and anti-smooth muscle (anti-actin) antibodies while viral hepatitis markers were negative. The patient had already been started on steroid therapy before the lab results were available, with rapid normalization of liver enzymes following treatment. A liver biopsy was not performed. The patient is currently on mesalazine 4 gr/day, and azathioprine 100 mg/day - oral steroids had been tapered and discontinued. Seven months after the initial diagnosis, the patient remains symptom-free. A high level of suspicion for autoimmune disorders is required when assessing patients with a history of COVID-19 infection, although diagnostic pathways remain the same, with generally good response and remission rates to conventional treatment.
新型冠状病毒肺炎（COVID-19）表现出多样的全身性临床症状，很像系统性自身免疫性疾病，并且在这两种病症中观察到的免疫反应存在显著相似性。有罕见报道称COVID-19感染引发了溃疡性结肠炎和自身免疫性肝炎。本文报告了一例既往健康的患者，该患者在COVID-19感染2个月后被诊断为类似溃疡性结肠炎的慢性结肠炎、自身免疫性胰腺炎以及疑似免疫介导性肝炎（AIH样肝炎）。一名接种了COVID-19疫苗的33岁男性，出现腹痛、恶心和呕吐2天。他在从COVID-19感染康复后还持续出现血性腹泻达2个月。血清淀粉酶和脂肪酶显著升高以及腹部CT扫描确诊为急性胰腺炎。结肠镜检查和组织病理学结果也证实诊断为类似溃疡性结肠炎的慢性结肠炎（梅奥内镜亚评分3分）。静脉注射泼尼松龙治疗72小时内，血性腹泻有明显改善。由于胰腺炎临床症状未缓解而进行的腹部MRI显示胰腺肿大，呈现延迟的弥漫性均匀强化，这些表现可能与自身免疫性胰腺炎相符。对肝转氨酶升高的检查显示抗核抗体和抗平滑肌（抗肌动蛋白）抗体滴度高，而病毒性肝炎标志物为阴性。在实验室结果出来之前患者就已经开始接受类固醇治疗，治疗后肝酶迅速恢复正常。未进行肝活检。患者目前服用美沙拉嗪4克/天和硫唑嘌呤100毫克/天，口服类固醇已逐渐减量并停药。初次诊断7个月后，患者仍无症状。在评估有COVID-19感染史的患者时，需要高度怀疑自身免疫性疾病，尽管诊断途径相同，对传统治疗的反应和缓解率总体良好。
