Appendicitis and COVID: cause or effect?

Area of Science:

• Gastroenterology
• Vascular Pathology
• Infectious Disease Complications

Background:

• Appendiceal vasculitis and phlebitis with vascular occlusion are rare pathological findings.
• COVID-19 infection has been associated with systemic veno-occlusive disease, particularly in hepatic pathology.
• Lymphoid aggregation with phlebitis in appendix specimens is an unusual observation.

Observation:

• A 27-year-old male presented with symptoms of acute appendicitis.
• The patient had recovered from a COVID-19 infection approximately 12 weeks prior to presentation.
• Computed tomography and operative findings confirmed acute appendicitis.

Findings:

• Histopathological examination of the surgically removed appendix revealed veno-occlusive vasculitis.
• Specifically, medium-sized venules within the appendix showed signs of phlebitis.
• The patient had no significant past medical history, indicating a potential link to recent COVID-19 infection.

Implications:

• This case underscores the potential for COVID-19 to induce uncommon vascular inflammatory responses beyond typical presentations.
• Appendiceal phlebitis, particularly veno-occlusive vasculitis, should be considered in patients with a history of COVID-19 presenting with appendicitis.
• Further research is warranted to elucidate the mechanisms linking SARS-CoV-2 infection to appendiceal vascular pathology.