Djordje Kralj¹*, Olga Odanovic¹, Tamara Kneževic Ivanovski¹, Slobodan Srećković¹, Tamara Knezevic Ivanovski¹, Ana Kalaba¹, Petar Svorcan^1,2 and Srđan Marković^1,2

¹Department of Gastroenterology and Hepatology, University Hospital Medical Center “Zvezdara”, Belgrade, Serbia
²Medical Faculty, University of Belgrade, Serbia

*Corresponding Author: Djordje Kralj, Department of Gastroenterology and Hepatology, University Hospital Medical Center “Zvezdara”, Belgrade, Serbia.

Received: June 07, 2024; Published: June 16, 2024

Abstract

Background: It is well known that some viruses can modify and even induce autoimmune diseases. There are several data that suggest association of COVID19 with onset of different autoimmune diseases.

Case Presentation: Therefore, we report a case of a female patient with the diagnosis of ulcerative colitis, initially presented as acute severe form in February 2021 when she was hospitalized as COVID19 negative. Flexible sigmoidoscopy revealed severely active ulcerative colitis (Mayo subscore 3), confirmed on histopathology. Therapy according to ECCO guidelines was initiated. Since optimal response after three days was achieved, maintenance therapy, Azathioprine with Infliximab, was planned because of the initial severe presentation. However, patient reported recurrence of symptoms with fever, abdominal pain, and increased C-reactive protein. After abdominal CT scan, in lower parts of the lung, ground glass opacities were seen, and rapid antigen test on COVID19 was positive. Since patient refused admission in COVID hospital, she was sent home. Anti-TNFα therapy (Infliximab) was started two weeks from full recovery from COVID19. Endoscopic remission was achieved at week 24. However, arthralgia and constant pain under the left rib cage persisted even after successful treatment of colitis. After rheumatologists’ examination, diagnosis of systemic lupus erythematosus was made in February 2022.

Conclusion: Two weeks after the resolution of symptoms in mild COVID19 cases, it is safe to start or continue with anti-TNFα therapy. IBD patients are susceptible individuals, hence regular follow up is recommended. There is a strong belief that in genetically predisposed patients, COVID19 can trigger autoimmune disease.

Keywords: Inflammatory Bowel Disease; Systemic Lupus Erythematosus; COVID-19; Gastroenterology

References

1. Baumgart DC and Sandborn WJ. “Inflammatory bowel disease: clinical aspects and established and evolving therapies”. Lancet 9573 (2007): 1641-1657.
2. Xavier RJ and Podolsky DK. “Unravelling the pathogenesis of inflammatory bowel disease”. Nature7152 (2007): 427-434.
3. Abraham C and Cho JH. “Inflammatory bowel disease”. The New England Journal of Medicine21 (2009): 2066-2078.
4. Ordás I., et al. “Ulcerative colitis”. Lancet 9853 (2012): 1606-1119.
5. Danese S and Fiocchi C. “Ulcerative colitis”. The New England Journal of Medicine18 (2011): 1713-1725.
6. Ananthakrishnan AN. “Epidemiology and risk factors for IBD”. Nature Reviews Gastroenterology and Hepatology4 (2015): 205-217.
7. Magro F., et al. “Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders”. Journal of Crohn's and Colitis6 (2017): 649-670.
8. Lewis JD., et al. “Use of the noninvasive components of the Mayo score to assess clinical response in ulcerative colitis”. Inflammatory Bowel Disease 12 (2008): 1660-1666.
9. Harbord M., et al. “Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 2: Current Management”. Journal of Crohn's and Colitis7 (2017): 769-784.
10. Ungaro R., et al. “Ulcerative colitis”. Lancet 10080 (2017): 1756-1770.
11. Monteleone G and Ardizzone S. “Are Patients with Inflammatory Bowel Disease at Increased Risk for Covid-19 Infection?”. Journal of Crohn's and Colitis9 (2020): 1334-1336.
12. Allocca M., et al. “Incidence and patterns of COVID-19 among inflammatory bowel disease patients from the Nancy and Milan cohorts”. Clinical Gastroenterology and Hepatology 9 (2020): 2134-2135.
13. D'Amico F., et al. “Inflammatory bowel disease management during the COVID-19 outbreak: a survey from the European Crohn's and Colitis Organization (ECCO)”. Gastroenterology 1 (2020): 14-16.
14. Danese S., et al. “Positioning therapies in ulcerative colitis”. . Clinical Gastroenterology and Hepatology6 (2020): 1280-1290.
15. Harbord M., et al. “Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 2: Current Management”. Journal of Crohn's and Colitis7 (2017): 769-784.
16. D'Amico F., et al. “Inflammatory bowel disease management during the COVID-19 outbreak: a survey from the European Crohn's and Colitis Organization (ECCO)”. Gastroenterology 1 (2020): 14-16.
17. Monteleone G and Ardizzone S. “Are Patients with Inflammatory Bowel Disease at Increased Risk for Covid-19 Infection?”. Journal of Crohn's and Colitis9 (2020): 1334-1336.
18. Danchenko N., et al. “Epidemiology of systemic lupus erythematosus: a comparison of worldwide disease burden”. Lupus5 (2006): 308-318.
19. Conway R and Carey JJ. “Risk of liver disease in patients with inflammatory bowel disease”. World Journal of Gastroenterology 4 (2016): 1610-1618.
20. Larsen S., et al. “Extraintestinal manifestations of inflammatory bowel disease: epidemiology, diagnosis, and management”. Annals of Medicine2 (2010): 97-114.
21. Narváez J., et al. “Systemic lupus erythematosus and inflammatory bowel disease: associated disorders?” Lupus8 (2004): 570-574.
22. Oliveira SB and Monteiro IM. “Diagnosis and management of inflammatory bowel disease in children”. BMJ 357 (2017): j2083.
23. Oldstone MB. “Molecular mimicry and autoimmune disease”. Cell6 (1987): 819-820.
24. Fujinami RS., et al. “Molecular mimicry, bystander activation, or viral persistence: infections and autoimmune disease”. Clinical Microbiology Review1 (2006): 80-94.
25. Galeotti C and Bayry J. “Autoimmune and inflammatory diseases following COVID-19”. Nature Reviews Rheumatology 8 (2020): 413-414.
26. Anaya JM., et al. “Post-COVID syndrome. A case series and comprehensive”. Autoimmune Review11 (2021): 102947.

Citation

Citation: Djordje Kralj., et al. “Case Report: Hidden Truth – Patient with Ulcerative Colitis and Systemic Lupus Erythematosus with Secondary Antiphospholipid Syndrome".Acta Scientific Clinical Case Reports 5.7 (2024): 35-39.

Copyright

Copyright: © 2024 Djordje Kralj., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.