Severe Refractory Diarrhea Associated with COVID-19: A Case Report
Akiyoshi Tsuboi1, Shuya Shigenobu1, Yuka Matsubara1
1Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan.
Case Reports in Gastroenterology
|July 17, 2024
Summary
Severe diarrhea after COVID-19 recovery can occur. This case highlights that refractory diarrhea, potentially due to immune response, may improve with methylprednisolone treatment.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Immunology
Background:
- Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, is linked to gastrointestinal issues.
- Refractory diarrhea post-COVID-19 recovery is an uncommon but reported complication.
Observation:
- A 50-year-old male with SARS-CoV-2 pneumonia developed severe, refractory diarrhea (6-7 L/day).
- Initial treatment for cytomegalovirus enterocolitis with ganciclovir was ineffective.
- The patient's severe diarrhea significantly improved after a 3-day course of intravenous methylprednisolone pulse therapy.
Findings:
- COVID-19-associated enterocolitis has a low prevalence and unclear pathogenesis.
- Severe post-COVID-19 diarrhea may stem from an abnormal immune response.
- Methylprednisolone pulse therapy was effective in resolving severe refractory diarrhea in this case.
Implications:
- Clinicians should consider COVID-19-associated enterocolitis in patients with persistent severe diarrhea after SARS-CoV-2 infection.
- Methylprednisolone should be considered for refractory diarrhea post-COVID-19, suggesting an immune-mediated mechanism.
- Further research is needed to elucidate the pathogenesis of COVID-19-associated enterocolitis and optimize treatment strategies.
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