Cytomegalovirus haemorrhagic enterocolitis associated with severe infection with COVID-19

We present a case of haemorrhagic enterocolitis in a patient with SARS-CoV-2 who recovered from respiratory failure after support with venovenous extracorporeal membrane oxygenation. We describe clinicopathological features consistent with the systemic coinfection/reactivation of cytomegalovirus (CMV) concurrent with COVID-19 infection and the protracted clinical course of resolution of gastrointestinal inflammation after the treatment of CMV infection. Stool PCR, abdominal CT perfusion scan and histological examination of ileal and colonic tissues excluded enterocolitis secondary to other causes of infection (common viral, bacterial and protozoal gastrointestinal pathogens), macrovascularand microvascular ischaemia and classic inflammatory bowel disease, respectively. We propose possible synergistic pathophysiologic mechanisms for enterocolitis complicating severe COVID-19 infection: (1) T lymphocyte depletion and immune response dysregulation, (2) use of immunomodulators in the management of severe COVID-19 infection and (3) high concentration of ACE-2 receptors for COVID-19 virus in the gastrointestinal tract.

Automated summary

This case report describes a patient with SARS-CoV-2 who developed haemorrhagic enterocolitis after recovering from respiratory failure with venovenous extracorporeal membrane oxygenation. The study suggests a possible link between systemic coinfection/reactivation of cytomegalovirus and the prolonged resolution of gastrointestinal inflammation in COVID-19 patients. Additionally, the proposed synergistic pathophysiologic mechanisms for enterocolitis complicating severe COVID-19 infection include T lymphocyte depletion, immune response dysregulation, use of immunomodulators, and high concentration of ACE-2 receptors in the gastrointestinal tract for COVID-19 virus.