Tsuboi Akiyoshi, Shigenobu Shuya, Matsubara Yuka, Hirata Issei, Tanaka Hidenori, Yamashita Ken, Yuge Ryo, Urabe Yuji, Arihiro Koji, Oka Shiro
Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan.
Department of Gastrointestinal Endoscopy and Medicine, Hiroshima University Hospital, Hiroshima, Japan.
Case Rep Gastroenterol. 2024 Jun 14;18(1):318-326. doi: 10.1159/000539413. eCollection 2024 Jan-Dec.
Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is frequently associated with various gastrointestinal symptoms, including abdominal pain, vomiting, and diarrhea. Moreover, several cases of refractory diarrhea have been reported after COVID-19 recovery. Herein, we present a case of severe refractory diarrhea associated with COVID-19.
A 50-year-old man with no comorbidities was admitted to our hospital with SARS-CoV-2 pneumonia. His respiratory status deteriorated, and ventilatory management, including extracorporeal membrane oxygenation, was needed. The patient's respiratory condition improved, resulting in a transfer to another hospital for rehabilitation. However, the patient developed diarrhea that worsened to 6,000-7,000 mL/day, and he was transferred to our hospital. We diagnosed the patient with enterocolitis caused by cytomegalovirus infection and treated him with ganciclovir on day 5 after transfer to our hospital. The diarrhea did not improve. We suspected enterocolitis associated with COVID-19 and administered a methylprednisolone pulse (intravenous injection, 1,000 mg/day for 3 days) on day 10 after transfer, resulting in a marked improvement in his symptoms. The prednisolone dose was tapered, and no recurrence of diarrhea was observed thereafter.
The prevalence of COVID-19-associated enterocolitis is low, and the pathogenesis of the disease remains unclear. Prednisolone administration should be considered in cases of post-COVID-19 symptoms of severe diarrhea due to a possible abnormal immune response related to COVID-19.
由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的2019冠状病毒病（COVID-19）常伴有各种胃肠道症状，包括腹痛、呕吐和腹泻。此外，有几例COVID-19康复后出现难治性腹泻的病例报道。在此，我们报告一例与COVID-19相关的严重难治性腹泻病例。
一名无合并症的50岁男性因SARS-CoV-2肺炎入住我院。他的呼吸状况恶化，需要包括体外膜肺氧合在内的通气管理。患者的呼吸状况有所改善，随后转至另一家医院进行康复治疗。然而，患者出现腹泻，且腹泻加重至每日6000 - 7000毫升，随后他又转回到我院。转至我院后第5天，我们诊断该患者为巨细胞病毒感染引起的小肠结肠炎，并用更昔洛韦对其进行治疗。腹泻并未改善。我们怀疑是与COVID-19相关的小肠结肠炎，并在转院后第10天给予甲泼尼龙冲击治疗（静脉注射，每日1000毫克，共3天），其症状得到明显改善。泼尼松龙剂量逐渐减少，此后未观察到腹泻复发。
COVID-19相关小肠结肠炎的患病率较低，其发病机制尚不清楚。对于COVID-19后出现严重腹泻症状的病例，由于可能存在与COVID-19相关的异常免疫反应，应考虑给予泼尼松龙治疗。
