Limited Additive Diagnostic Impact of Isolated Gastrointestinal Involvement for the Triage of Children with Suspected COVID-19

The strategy for the selection of patients with a suspected SARS-CoV-2 infection is relevant for the organization of a children’s hospital to provide optimal separation into COVID-19 and non-COVID-19 areas and pathways. We analyzed the proportion of children with COVID-19 presenting with gastrointestinal (GI) symptoms in 137 consecutive patients admitted between January 2020 and August 2021. GI symptoms were present as follows: diarrhea in 35 patients (26%), vomiting in 16 (12%), and both of them in five (3%); the combination of fever, respiratory symptoms, and diarrhea was observed in 16 patients (12%). Of the 676 adult patients with COVID-19 admitted to our hospital in the same time interval, 62 (9.2%) had diarrhea, 30 (4.4%) had vomiting, and 11 (1.6%) had nausea; only one patient, a 38-year-old male, presented with isolated GI symptoms at the diagnosis. Although diarrhea was observed in one quarter of cases, one-half of them had the complete triad of fever, respiratory syndrome, and diarrhea, and only five had isolated diarrhea, of which two were diagnosed with a Campylobacter infection. The occurrence of either respiratory symptoms or gastrointestinal symptoms in our patients was not related to the patient age, while younger children were more likely to have a fever. Of the 137 patients, 73 (53%) could be tested for their serum level of SARS-CoV-2 specific IgG antibodies. The observed titer ranged between 0 (n = 3) and 1729 BAU/mL (median, 425 BAU/mL). Of 137 consecutive patients with COVID-19 admitted to our referral children’s hospital, only three presented with an isolated GI manifestation. It is interesting to note that this finding turned out to be fully in keeping with what was observed on adult patients with COVID-19 in our hospital. The additive diagnostic impact of gastrointestinal involvement for the triage of children with suspected COVID-19 appears limited.

Crohn’s Disease of the Vulva: a Case Report

Crohn’s disease is a multi-systemic chronic inflammatory disease that can affect various organs besides the gastrointestinal tract such as joints, uvea, and the skin. Vulvar Crohn’s disease is a rare entity occurring with vulvar lesions that show typical Crohn’s disease granulomatous inflammation but are not contiguous with the gastrointestinal involvement. Vulvar Crohn’s disease can be easily confused with other granulomatous diseases and awareness that such involvement may precede gastrointestinal symptoms must be raised. Few cases of vulvar Crohn’s disease have been reported in the literature to date. Here, we report a case of a 43-year-old woman with a 6-month history of a vulvar lesion; the patient was diagnosed with Crohn’s disease of the large bowel just over a year ago.

Clinical Analysis of Chronic Active EBV Infection Involving Gastrointestinal Tract

Objective This study aimed to analyze the clinical manifestation, prognosis, and risk factors of pediatric chronic active Epstein-Barr virus infection (CAEBV) associated with gastrointestinal tract involvement.Methods This retrospective case series study included pediatric CAEBV associated with gastrointestinal tract involvement treated at Beijing Children’s Hospital, Capital Medical University from June 2017 to Jun 2021. The control group was consisted of Children with CAEBV without gastrointestinal involvement. The clinical manifestations, laboratory and ultrasound examinations, treatment and prognosis of the children were observed.Results There were 15 children with CAEBV combined with gastrointestinal involvement, including 11 males and 4 females, accounting for 20.8% (15/72) of CAEBV patients in the same period, with an onset median age of 3.71 (0.64-14.47) years. The most common clinical manifestation at onset was diarrhea (13/15). Gastrointestinal ultrasound showed air accumulation accompanied by intestinal wall swelling and thickening, mild to moderate swelling of the surrounding mesentery and omentum, and enhanced echo. The endoscopic features were hyperemia, edema, and ulcers of variable morphological characteristics. Pathological examination showed lymphocyte infiltration with EBER (+), and the common involvement locations were the colon (n=6) and gastric antrum (n=3). The median follow-up time was 13.26 (0.31-51.89) months. Ten patients survived, and 5 patients died (including one patient who died of intestinal perforation due to necrotizing enterocolitis). Compared with the control group, the case group had higher levels of alanine aminotransferase, aspartate aminotransferase and whole blood EBV-DNA copies (P=0.038, 0.040 and < 0.001) and lower NK cell activity (P < 0.001). The 3-year overall survival rate of the case group was significantly lower than that of the control group (59.3%±12.9% vs. 79.4%±4.9%, P=0.021).Conclusion The incidence of CAEBV with gastrointestinal tract involvement was low. The most common involvement location was colon. CAEBV with gastrointestinal involvement had poor prognosis. Patients who had high whole blood EBV-DNA copy levels early in their illness were more likely to develop gastrointestinal involvement.

Compromiso gastrointestinal inusual en paciente pediátrico con vasculitis asociada a anticuerpos anticitoplasma de neutrófilos. Reporte de un caso

Vasculitis is characterized by presenting inflammation of the wall of blood vessels, one type of these diseases are those associated with anti-neutrophil cytoplasm antibodies. They usually occur in adulthood and are rare in childhood. The disease generally affects the lung, kidney, and skin, with gastrointestinal involvement being rare. Here we describe the case of a pediatric patient with gastrointestinal bleeding secondary to ANCA positive vasculitis. Endoscopy revealed patchy erythematous lesions and wall hematoma at the level of the colon. Although we report a fairly infrequent clinical condition, it is not without complications. We believe it is appropriate to suspect it, first of all, intestinal involvement where the underlying inflammatory process is not clear, even more so when it involves other organs.

COVID-19 and the Gastrointestinal Tract

Since it was discovered at the end of 2019; the pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has made a serious public health threat worldwide, with over 175 million confirmed cases reported globally. Even when COVID-19 was initially considered a respiratory disease, it was actually known to be multisystemic, with gastrointestinal involvement a common clinical finding. Furthermore, COVID-19 may affect patients with gastrointestinal comorbidities, being the clinical intersectionality of utmost interest for gastroenterologists; critical care physicians and all the healthcare team taking care of COVID-19 patients. The present article presents a brief review of the reported gastrointestinal manifestations of COVID-19 disease in both previously healthy individuals and in patients with gastrointestinal comorbidities.

Triple therapy with adalimumab, ustekinumab and methotrexate for induction of remission in moderate to severe ileocolonic Crohn’s disease with upper gastrointestinal involvement in a biologic-experienced individual

Induction of remission in biologic-experienced individuals with moderate to severe Crohn’s disease (CD) can be a challenge. We hereby present a case of CD with secondary non-response to infliximab. Adding methotrexate and switching to ustekinumab plus methotrexate did not stop the inflammatory process. Therefore, combination therapy with two classes of biologics consisting of ustekinumab and adalimumab plus methotrexate was initiated. He achieved clinical remission in 4 weeks and remained on triple therapy for 6 months which was subsequently tailored to adalimumab/methotrexate combination therapy due to insurance restriction on ustekinumab. He remained in remission for the duration of follow-up, 14 months after initiation of triple therapy and 8 months after switching to methotrexate/adalimumab biologic monotherapy. Triple therapy with anti-TNF, IL-12/23 inhibitor and methotrexate could potentially be an option for induction of remission in biologic-experienced individuals with good initial clinical response to anti-TNF agents.

A Rare Case of Primary Pulmonary Amoebiasis without Gastrointestinal Involvement: A Case Report

Introduction: The main pathogen of amoebiasis is Entamoeba histolytica which is very common in tropical and developing countries, where sanitation, hygiene, and low socio-economic status are major problems. The most common site of infection is the intestinal mucosa. For extraintestinal amoebiasis, the most common sites are the liver, followed by the lungs and brain.Case: A 15-year-old male was presented to the ER with chief complaint of breathlessness for the last 10 days, accompanied by productive coughing with dark brown sputum and pain on lower right chest. The patient had fever while the disease progressed. Gastrointestinal symptoms were denied. Physical examination showed lowered breathing sound on the right lung, dullness on lower right chest, and usage of accessory breathing muscles. USG found heteroechoic lesion of 8x7cm in size suspicious of lung abscess, later on confirmed as Entamoeba histolytica found in sputum sample, while abdominal USG showed no abnormality. The patient was admitted for antibiotic therapy and consultation to cardiothoracic surgeon.Discussion: One of the rarest routes of amoebiasis is primary deposition of cysts to the lungs through aspiration. Pulmonary amoebiasis often causes abscess formation, produces brown-colored sputum called “anchovy sauce”. It is notable that we found one of the rarest cases of amoebiasis infection, where there is a pulmonary infection without any intestinal involvement.Conclusion: Whilst infection of primary pulmonary amoebiasis is very rare, it is still an important etiology to put on the differential diagnosis of pulmonary abscess. Therefore, sputum examination or biopsy is required even when there are no gastrointestinal disturbances.

Hepatobiliary and Gastrointestinal Involvement in Langerhans Cell Histiocytosis—Spectrum of Three Cases

Langerhans cell histiocytosis (LCH) is a rare group of disorder, due to clonal neoplastic proliferation of dendritic cells in the bone marrow expressing a Langerhans cell phenotype.1 This disease particularly affects the pediatric age group and young adults and often presents with skin rashes, lung infiltrates, and bone lesions. It can also manifest with endocrine dysfunction and hematopoietic disorders. Involvement of gastrointestinal tract is very rare. Herein, we present a spectrum of three cases with gastrointestinal involvement.