key: cord-283034-ebely0rx
authors: Brunet, E; Casabella, A; Calzado, S; Villoria, A
title: Ileitis as the exclusive manifestation of covid-19. The first reported case
date: 2020-10-19
journal: Gastroenterol Hepatol
DOI: 10.1016/j.gastrohep.2020.10.001
sha: 
doc_id: 283034
cord_uid: ebely0rx

nan

4 Departament de Medicina. Universitat Autònoma de Barcelona. 5 CIBERehd, Instituto de Salud Carlos III.

* The patient has given his informed consent to publish the information included in the article.

Eduard Brunet Mas We present the case of a 47-year-old female worker of an elderly nursing home with no previous significant medical history was admitted to the emergency room. She reported 10 days of right lower quadrant abdominal pain, high fever (maximum 39.5ºC) and non-bloody diarrhea. The patient did not report any respiratory symptoms. No other family members were affected. Two nasopharyngeal and oropharyngeal swab specimens performed before admission had been negative for SARS-CoV-2. Respiratory auscultation was strictly normal, and pain was noted on the palpation of the right lower abdominal quadrant. Blood test showed markedly increased inflammatory parameters (leukocytes, D-Dimer, ferritin C-reactive protein). Chest X-ray was normal (figure 1a). Abdominal CT scan showed inflammatory signs in the distal ileum (figure 1b).

The pulmonary images of the abdominal CT scan were normal (figure 1c).

Empiric treatment with ceftriaxone, metronidazole and azithromycin was started. The patient was admitted to the gastroenterology unit after a confirmatory negative SARS-CoV-2 NAAT The patient recovered completely, with normalization of the previous blood test abnormalities.

A SARS-CoV-2 control NAAT in rectal swab was negative before discharge from hospital. The patient remains asymptomatic after three-month follow-up.

To our knowledge, our report is the first well-documented case of SARS-CoV-2 intestinal infection without evidence of pulmonary involvement. The multiple negative nasopharyngeal swabs plus the normal chest X-ray and CT findings rule out pulmonary infection. We report a patient with SARS-CoV-2 infection apparently limited to the bowel. However, no recommendations or conclusions can be drawn from this case report. The patient had an important delay between the admission and the colonoscopy and, despite we found a radiological ileitis, endoscopic mucosa was normal.

In conclusion, SARS-CoV-2 may occur with an exclusive intestinal symptoms. Is important for clinicians to know and recognize this clinical presentation, a rectal swab may be necessary to establish the diagnosis. 

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