Terminal Ileitis as the Exclusive Manifestation of COVID-19 in Children.
Lea Maria SchulerBarbara FalkensammerPeter OrlikMichael AuckenthalerChristof KranewitterDavid BanteDorothee von LaerFranz-Martin FinkPublished in: Microorganisms (2024)
The clinical presentation, organ involvement, and severity of disease caused by SARS-CoV-2 are highly variable, ranging from asymptomatic or mild infection to respiratory or multi-organ failure and, in children and young adults, the life-threatening multisystemic inflammatory disease (MIS-C). SARS-CoV-2 enters cells via the angiotensin-converting enzyme-2 receptor (ACE-2), which is expressed on the cell surfaces of all organ systems, including the gastrointestinal tract. GI manifestations have a high prevalence in children with COVID-19. However, isolated terminal ileitis without other manifestations of COVID-19 is rare. In March 2023, two previously healthy boys (aged 16 months and 9 years) without respiratory symptoms presented with fever and diarrhea, elevated C-reactive protein levels, and low procalcitonin levels. Imaging studies revealed marked terminal ileitis in both cases. SARS-CoV-2 (Omicron XBB.1.9 and XBB.1.5 variants) was detected by nucleic acid amplification in throat and stool samples. Both patients recovered fast with supportive measures only. A differential diagnosis of acute abdominal pain includes enterocolitis, mesenteric lymphadenitis, appendicitis, and more. During SARS-CoV-2 epidemics, this virus alone may be responsible for inflammation of the terminal ileum, as demonstrated. Coinfection with Campylobacter jejuni in one of our patients demonstrates the importance of a complete microbiological workup.
Keyphrases
- sars cov
- young adults
- respiratory syndrome coronavirus
- end stage renal disease
- angiotensin converting enzyme
- coronavirus disease
- nucleic acid
- ejection fraction
- newly diagnosed
- chronic kidney disease
- peritoneal dialysis
- angiotensin ii
- stem cells
- abdominal pain
- high resolution
- single cell
- risk factors
- depressive symptoms
- gene expression
- preterm infants
- signaling pathway
- induced apoptosis
- photodynamic therapy
- bone marrow
- liver failure
- respiratory failure
- mesenchymal stem cells
- physical activity
- copy number
- antimicrobial resistance
- preterm birth
- low birth weight
- cell cycle arrest
- infectious diseases
- childhood cancer