Autopsy and Case Reports
Autopsy and Case Reports
Clinical Case Report and Review

Ulcerative colitis after SARS-CoV-2 infection

Sofia Kartsoli; Spyridon Vrakas; Dimitrios Kalomoiris; Kassiani Manoloudaki; Vasileios Xourgias

Downloads: 6
Views: 1521


Although severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) affects mainly the respiratory system, the gastrointestinal tract is also considered a site of viral activity. We hereby present the case of a 74-year-old male patient with the diagnosis of new-onset ulcerative colitis. One month earlier, the patient presented fever, running nose, and diarrhea and was tested positive for SARS-CoV-2. Studies with COVID-19 patients revealed significant changes in gut microbiota composition and alterations in immune responses that could lead to chronic inflammation and manifestations of inflammatory bowel disease. We review additional cases of ulcerative colitis presented after SARS-CoV-2 infection and summarize the possible mechanisms that underlie the gastrointestinal abnormalities in COVID-19 patients.


COVID-19, SARS-CoV-2, Ulcerative colitis


1 Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33. PMid:31978945.

2 Cheung KS, Hung IFN, Chan PPY, et al. Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from a hong kong cohort: systematic review and meta-analysis. Gastroenterology. 2020;159(1):81-95. PMid:32251668.

3 Porter RJ, Kalla R, Ho G-T. Ulcerative colitis: recent advances in the understanding of disease pathogenesis. F1000Res. 2020;9:1-13. PMid:32399194.

4 Shen Z-H, Zhu C-X, Quan Y-S, et al. Relationship between intestinal microbiota and ulcerative colitis: mechanisms and clinical application of probiotics and fecal microbiota transplantation. World J Gastroenterol. 2018;24(1):5-14. PMid:29358877.

5 Sun L, Nava GM, Stappenbeck TS. Host genetic susceptibility, dysbiosis, and viral triggers in inflammatory bowel disease. Curr Opin Gastroenterol. 2011;27(4):321-7. PMid:21483258.

6 García Rodríguez LA, Ruigómez A, Panés J. Acute gastroenteritis is followed by an increased risk of inflammatory bowel disease. Gastroenterology. 2006;130(6):1588-94. PMid:16697722.

7 Taxonera C, Fisac J, Alba C. Can COVID-19 trigger de novo inflammatory bowel disease? Gastroenterology. 2021;160(4):1029-30. PMid:33221408.

8 Imperatore N, Bennato R, D’Avino A, Lombardi G, Manguso F. SARS-CoV-2 as a trigger for de novo ulcerative colitis. Inflamm Bowel Dis. 2021;27(7):e87-8. PMid:33616182.

9 Calabrese E, Zorzi F, Monteleone G, Del Vecchio Blanco G. Onset of ulcerative colitis during SARS-CoV-2 infection. Dig Liver Dis. 2020;52(11):1228-9. PMid:32601030.

10 Aydın MF, Taşdemir H. Ulcerative colitis in a COVID-19 patient: a case report. Turk J Gastroenterol. 2021;32(6):543-7. PMid:34405821.

11 Kalil AC. Treating COVID-19: off-label drug use, compassionate use, and randomized clinical trials during pandemics. JAMA. 2020;323(19):1897-8. PMid:32208486.

12 Effenberger M, Grabherr F, Mayr L, et al. Faecal calprotectin indicates intestinal inflammation in COVID-19. Gut. 2020;69(8):1543-4. PMid:32312790.

13 Dahiya DS, Kichloo A, Albosta M, Pagad S, Wani F. Gastrointestinal implications in COVID-19. J Investig Med. 2020;68(8):1397-401. PMid:32928903.

14 Ding S, Liang TJ. Is SARS-CoV-2 also an enteric pathogen with potential fecal-oral transmission? A COVID-19 virological and clinical review. Gastroenterology. 2020;159(1):53-61. PMid:32353371.

15 Xu X, Han M, Li T, et al. Effective treatment of severe COVID-19 patients with tocilizumab. Proc Natl Acad Sci USA. 2020;117(20):10970-5. PMid:32350134.

16 Zhang Y, Li J, Zhan Y, et al. Analysis of serum cytokines in patients with severe acute respiratory syndrome. Infect Immun. 2004;72(8):4410-5. PMid:15271897.

17 Sadeghi A, Tahmasebi S, Mahmood A, et al. Th17 and Treg cells function in SARS-CoV2 patients compared with healthy controls. J Cell Physiol. 2021;236(4):2829-39. PMid:32926425.

18 Dvornikova KA, Bystrova EY, Churilov LP, Lerner A. Pathogenesis of the inflammatory bowel disease in context of SARS-COV-2 infection. Mol Biol Rep. 2021;48(7):5745-58. PMid:34296352.

19 Hashimoto T, Perlot T, Rehman A, et al. ACE-2 links amino acid malnutrition to microbial ecology and intestinal inflammation. Nature. 2012;487(7408):477-81. PMid:22837003.

20 Guinane CM, Cotter PD. Role of the gut microbiota in health and chronic gastrointestinal disease: understanding a hidden metabolic organ. Therap Adv Gastroenterol. 2013;6(4):295-308. PMid:23814609.

21 Zuo T, Zhang F, Lui GCY, et al. Alterations in gut microbiota of patients with COVID-19 during time of hospitalization. Gastroenterology. 2020;159(3):944-955.e8. PMid:32442562.

22 Gu S, Chen Y, Wu Z, et al. Alterations of the gut microbiota in patients with coronavirus disease 2019 or H1N1 influenza. Clin Infect Dis. 2020;71(10):2669-78. PMid:32497191.

23 Alipour M, Zaidi D, Valcheva R, et al. Mucosal barrier depletion and loss of bacterial diversity are primary abnormalities in paediatric ulcerative colitis. J Crohn’s Colitis. 2016;10(4):462-71. PMid:26660940.

Submitted date:

Accepted date:

Publication date:

626ac40ea953954a7b213353 autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections