A New Onset of Ulcerative Colitis Post-COVID-19: A Case Report

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) can cause not only respiratory symptoms but also gastrointestinal symptoms. In addition, there is increased concern about the autoimmune complications of coronavirus disease 2019 (COVID-19). This report describes a 21-year-old non-smoking Caucasian male with a history of acute pancreatitis but no other medical issues or family history who developed a new onset of ulcerative colitis after the second episode of COVID-19. He had three doses of the BNT162b2 mRNA COVID-19 vaccine. Two months after the first episode of COVID-19, he had the third dose of the vaccine. Nine months after the third dose, he had the second episode of COVID-19, during which he was mildly unwell for three days, recovered, and did not require any anti-viral medication or antibiotics. One week post the second episode of COVID-19, he developed diarrhoea and abdominal pain. It then progressed to bloody diarrhea. We diagnosed ulcerative colitis based on his clinical symptoms, biopsy changes, and the exclusion of other causes. This case raises awareness of developing ulcerative colitis concurrently with or following COVID-19. It is essential to thoroughly investigate COVID-19 patients who have diarrhea or bloody diarrhea and not consider it a common gastroenteritis or a simple gastrointestinal manifestation of COVID-19. Although we cannot confirm the association with a case study, further research is needed to confirm the causal or incidental relationship and observe any increased incidence of ulcerative colitis in the future as secondary to COVID-19.