key: cord-0998417-2jbg8bya
authors: Hormati, Ahmad; Ghadir, Mohammad Reza; Saeidi, Mohammad; Aminnejad, Reza; Khodadust, Fatemeh; Afifian, Mahboubeh; Ahmadpour, Sajjad
title: Dysentery as a rare GI symptom found in COVID-19 patients
date: 2020-07-03
journal: Gastroenterol Hepatol
DOI: 10.1016/j.gastrohep.2020.06.005
sha: 90362a80a441cb26b3813e5166c909122323fa9b
doc_id: 998417
cord_uid: 2jbg8bya

nan

J o u r n a l P r e -p r o o f Coronavirus Disease 2019 (COVID-19) caused by SARS-CoV-2 first started in Wuhan, China, and soon turned to a pandemic and still continue to spread across the world. 1, 2 With an increasing number of COVID-19 cases outside of China, our clinics in Shahid Beheshti Hospital, Qom city, was faced with a large number of patients who were suspected of being infected with the SARS-CoV-2. Following the outbreak of COVID-19, the prevalence of gastrointestinal (GI) tract symptoms significantly goes up. This incidence in COVID-19 patients is well documented in literatures. 3 After February 20, 2020, the day that Iran reported as the start of COVID-19 outbreak, the number of patients referred to our GI clinic was unusually increased. The most important complaint of patients was the incidence of some unusual GI symptoms resistant to medication. 4

One of the questions that need to be answered promptly is that whether the incidence of rare GI symptoms is possible in confirmed COVID pneumonia patients.

The answer to this question may help physicians take better diagnostic and therapeutic approaches for patients with this symptom. Currently, we have reported the clinical data in details as well as the result of chest CT of a COVID-19 patient with dysentery.

A 43-year-old woman was referred to our gastroenterology clinic, complaining from dysentery for one week. She did not mention any cough, dyspnea or respiratory disorders. Her past medical history was unremarkable and she ignored smoking, Page 4 of 11 J o u r n a l P r e -p r o o f drinking or using any drugs and medications. Respiratory rate: 18 per minute and body temperature from oral root: 37.5-38°C. In order to accurately evaluate the patient, laboratory test was performed. The results are summarized in ( Table 1 ). The levels of CRP, LDH and ESR 1h were higher than the normal range and were equal to 8.4, 400 and 21 respectively. Alkaline phosphatase, amylase serum and bilirubin values of the patient were in normal range. Medication with ciprofloxacine, 500 mg and metrodinazole, 500 mg was started after the first symptoms of dysentery, to reduce the volume of diarrhea and severe dehydration. Due to the persistence of diarrhea and the lack of therapeutic response to medications, as well as evaluation for the probability of inflammatory bowel disease (IBD) in the patient, colonoscopy was performed which was resulted in patchy erythema (Fig. 1) . Also, pathological finding was associated with the infiltration of inflammation cells which made us suspect infectious (viral) colitis.

Since the incidence of such GI symptoms coincided with the COVID-19 outbreak in Iran, and also more importantly since the patients reported to reside in high risk areas, we suspected patients to be infected by SARS-CoV-2. Therefore, for more validation, laboratory-confirmed COVID pneumonia was performed by using SARS-CoV-2 conventional polymerase chain reaction assay and sequencing of the polymerase chain reaction (PCR) amplicons, which was reported to be positive for the patient. After performing chest CT scan, we noticed the bilateral lung involvement, as revealed demonstrated that among adult patients, some common respiratory symptoms were followed by diarrhea. 3 Previously, we reported that infected patients with COVID-19 can present some unusual GI symptoms. 4 These symptoms were resistant to medications and in some cases without any medications, they subsided.

At the age of COVID-19 crisis, in some patients, GI physicians may face rare GI symptoms such as dysentery, hepatic involvement or other ones in patients. Therefore, it is necessary that all GI physicians should be aware of the possible occurrence of these symptoms as an important prognosis of COVID pneumonia. Although, in this letter we only documented one case of this issue, at the age of COVID-19, all rare GI symptoms should be exactly addressed in new referred patients to GI clinic. 

Successful containment of COVID-19: the WHO-Report on the COVID-19 outbreak in China

Novel coronavirus: where we are and what we know

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): the epidemic and the challenges

The authors would like to thank Sanam Ahmadpour for her contribution to the edit of the present manuscript.