Franciscan St. James Hospital Olympia Fields, IL, United States
Navkiran Randhawa, DO1, Es-Haq Hassanin, DO2, Sukhbir Randhawa, DO3 1Franciscan St. James Hospital, Olympia Fields, IL; 2University of Texas Health Science Center at Tyler, Tyler, TX; 3Samaritan Medical Center, Watertown, NY
Introduction: Coronavirus-2019 (COVID-19) presents with a wide spectrum of clinical manifestations and can affect various organ systems. Common gastrointestinal symptoms of the virus include diarrhea, nausea, and vomiting. Toxic megacolon, however, has not been cited in medical literature to be a side effect of the virus. We present a case of toxic megacolon that progressed in the setting of active COVID-19 infection.
Case Description/Methods: A 62 year old, Hispanic male with a past medical history of hypertension, hyperlipidemia, Insulin dependent type 2 diabetes mellitus and COPD presented to the emergency room with a chief complaint of acute dyspnea with hypoxemia. Initial chest x-ray demonstrated extensive interstitial and alveolar airspace opacities suspicious for COVID-19 pneumonia. A COVID-19 PCR test was positive and the patient was admitted for acute hypoxic respiratory failure. The patient was given Tocilizumab for COVID-19, however, his oxygen requirement continued to increase on heated high flow nasal cannula. On day 10 of admission, the patient began to have about ten, loose, watery bowel movements a day. An abdominal x-ray revealed large bowel gas with dilation and a peak bowel diameter of 16.3 cm. This was confirmed with a computed tomography abdomen and pelvis with and without contrast. He then developed a fever of 101.3 degrees Fahrenheit, tachycardia in the 120s, hypotension, and a leukocytosis of 29,100 confirming the diagnosis of toxic megacolon. Testing for clostridium difficile (C diff) toxin was negative x2. He did not have a known history of inflammatory bowel disease, occupational exposures, HIV, recent medication use that may cause toxic megacolon, or recent travel prior to his hospitalization. Pre-emptive treatment of C. diff was initiated without resolution of his symptoms. The patient had a cardiopulmonary arrest soon after and his family requested cessation of CPR.
Discussion: Both the short and long-term manifestations of COVID-19 have not been well-studied given the unexpected progression of the pandemic. Although GI symptoms are well known to be associated with the virus, toxic megacolon is not. This case report aims to emphasize the importance of appropriate abdominal imaging if GI symptoms begin to manifest with COVID-19. Early diagnosis will allow early symptomatic treatment as well as early surgical evaluation to decrease the likelihood of perforation.
Figure: Image 1. Dilated Colon
Navkiran Randhawa indicated no relevant financial relationships.
Es-Haq Hassanin indicated no relevant financial relationships.
Sukhbir Randhawa indicated no relevant financial relationships.
Navkiran Randhawa, DO1, Es-Haq Hassanin, DO2, Sukhbir Randhawa, DO3. P2309 - Toxic Megacolon as a Potential Complication Associated with COVID-19, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.