De Novo Crohn's Disese Triggered After COVID-19 More Than an Infectious Disease?
Kuppusamy Senthamizhselvan, MD, DM, Rajendran Ramalingam, MD, Pazhanivel Mohan, MD, et al
ACG Case Rep J. August 2021 - Volume 8 - Issue 8 - p e00652
Senthamizhselvan, et al. describe a previously healthy patient who had a mild SARS-CoV-2 infection but developed new onset oral ulcers, non-bloody diarrhea, peripheral arthropathy, and abdominal pain shortly after her infection resolved. An ileocolonoscopy showing multiple ulcers from the descending colon and terminal ileum with histopathology consistent with Crohn’s disease and noted presence of granulomas. She was prescribed a steroid taper and sulfasalazine by rheumatology for arthralgias with clinical improvement. This case highlights increasing reports of new onset immune mediated inflammatory diseases (IMID) after SARS-CoV-2 infection. The mechanism is unclear at this time but molecular mimicry, unregulated immune activation, or loss of self-tolerance possibly related to lymphopenia are proposed mechanisms. It is also unclear if the SARS-CoV-2 unmasks clinically silent IMID or truly triggers de novo IMID. As we learn more about the virus, we will be able to answer these gaps in knowledge and potentially uncover mechanisms involved in the pathogenesis of certain IMIDs that may lead to developing novel biomarkers or therapeutic targets.
Phillip Gu, MD
Cedars-Sinai Medical Center
ACG Case Reports Journal