Inflammatory Bowel Disease Presenting With Concurrent COVID-19 Multisystem Inflammatory Syndrome

Abstract

Coronavirus disease 2019 is associated with a postinfectious multisystem inflammatory syndrome in children (MIS-C). This syndrome is marked by cytokine storm and multiorgan dysfunction, often affecting the gastrointestinal tract, the heart, and the hematopoietic system. We describe the case of a 16-year-old boy with an initial presentation of severe inflammatory bowel disease and concurrent MIS-C. He presented with abdominal pain, diarrhea, and hematochezia and met criteria for the systemic inflammatory response syndrome. Laboratory inflammatory profiling revealed markedly elevated ferritin, D-dimer, C-reactive protein, soluble interleukin 2, and interleukin 6 levels. Endoscopy and colonoscopy revealed severe active gastroduodenitis, patchy colitis, and a normal-appearing terminal ileum. The patient was treated with a combination of steroids, intravenous immunoglobulin, and infliximab, and his symptoms slowly resolved over a 3-week period. In this case, we describe coincident MIS-C with a remarkably severe and difficult-to-treat initial presentation of inflammatory bowel disease and highlight the need to investigate the effect of coronavirus disease 2019 and MIS-C on inflammatory disorders.

FIGURE 1

A, Severe gastritis in the body of the stomach (left), severe duodenitis in the duodenal bulb (middle), and severe colitis in the sigmoid colon (right) noted on endoscopy. B, Corpus mucosa with active gastritis and expansile lamina propria lymphoplasmacytic infiltrate (left, arrow), ulcerated duodenal mucosa with vasculitis-like involvement of a blood vessel (middle), and severe active colitis with mucosal ulceration (right) (original magnification ×400). C, Course of laboratory inflammatory markers (green: ferritin, blue: D-dimer, yellow: CRP), stool output (maroon bars), and treatment (gray bars and arrows). IV, intravenous.