Course of COVID-19 in Patients with Inflammatory Bowel Disease: Regional Experience

Aim: to study the course of COVID-19 in patients with inflammatory bowel diseases (IBD) using the example of the region of the Republic of Tatarstan.Material and methods. The study included 101 patients diagnosed with IBD and COVID-19, who were observed in two infectious diseases hospitals in Kazan (Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan and City Clinical Hospital No. 7) and on an outpatient basis from April 2020 to March 2022. All patients underwent physical examination, laboratory and instrumental diagnostic methods, including a PCR test for SARSCoV-2. Chest computed tomography was performed in patients with clinical signs of moderate to severe COVID-19.Results. Ulcerative colitis (UC) was diagnosed in 60 (59.4 %) patients, Crohn's disease (CD) — in 41 (40.6 %) patients. The mean age of the patients was 41.0 ± 14.7 years, of which 59 (58.4 %) were men and 42 (41.6 %) were women. A comparative analysis of patients with and without IBD and CT-verified lung disease was carried out. It was found that the development of viral pneumonia was influenced by age over 55 years (39.2 ± 9.7 vs. 46.3 ± 10.6, p < 0.05), increased Body Mass Index (BMI) (23.1 ± 5.35 vs. 30.25 ± 6.17, p < 0.05), hypertension (6 (8.3 %) vs. 8 (27.6 %), p < 0.05), diabetes mellitus (2 (2.7 %) vs. 5 (17.2 %), p < 0.05), the use of corticosteroids in the treatment of IBD (8 (11.1 %) vs. 10 (34.5 %), p < 0.05). In a comparative analysis of patients with IBD and COVID-19 from the SECURE-IBD database and own data, it was found that the average age of patients was comparable (42.7 vs 41.0). At the same time, in our group of male patients, there were slightly more people with DM, increased BMI, and an active course of IBD. The proportion of hospitalized patients was higher. In our cohort, there were fewer patients receiving biological therapy, but more patients on 5-aminosalicylic acid (5-ASA) and systemic corticosteroids. At the same time, lethal outcomes were comparable.Conclusion. In patients with IBD, the development of viral pneumonia was influenced by known risk factors for COVID-19: age over 55 years (p < 0.05, odds ratio (OR) 3.153), increased BMI (p < 0.05, OR 1.667), hypertension  (p < 0.05, OR 2.724), diabetes (p < 0.05, OR 1.489), as well as the use of systemic corticosteroids (p < 0.05, OR 1.5)

A rare case of fever as the main symptom of Crohn's disease manifestation

Crohn's disease is a chronic, recurring gastrointestinal tract disease of unknown etiology with alternating periods of exacerbations and remissions; however, some patients can have a fulminant disease with predominance of fever. In some cases, extraintestinal manifestations of the disease (arthritis, sacroiliitis, aphthous stomatitis) come to the fore. This paper presents a clinical case of a 46 years old patient Z., who was treated in the Republican Clinical Hospital (Kazan, Russia). His past history was remarkable for a painful ulceration of the oral mucosa about 1.5 months ago, after a planned replacement of a removable prosthesis on the lower jaw. The patient was diagnosed with "decubital ulcer of the oral mucosa in the right retro-molar area"; malignancies were excluded, and anti-inflammatory therapy was initiated. Then he had fever of up to 39.5 °C and abdominal pains. The infectious causes of fever were excluded, abdominal ultrasound showed no free fluid in the abdominal cavity, and macroscopic segmental erosive-ulcerative changes of the colon, specific for Crohn's disease were found at colonoscopy. Intravenous prednisolone was initiated, with augmentation of infusions and administration of protein and antibacterials. The next day abdominal pain became more severe, with vomiting, abdominal distension, Blumberg's sign; blood pressure was 90/60 mm Hg and heart rate 120 beats perminute. Abdominal ultrasound showed free fluid in the abdominal cavity; dilated intestine loops with horizontal fluid levels were seen at X-ray. The diagnosis was "advanced peritonitis, hollow organ perforation", and emergency laparotomy was performed that showed multiple perforations of the colon and sigmoid, diffuse fibrinous-purulent fecal peritonitis. Colectomy and end ileostomy were performed. Despite intensive therapy in the intensive care unit, the patient's general condition continued to worsen, and two days after the operation, with deterioration of cardiovascular failure, he died. Based on the histological examination of the colon and the autopsy results, the diagnosis of Crohn's disease was confirmed. Thus, the presence of febrile fever, as the leading syndrome, without any intestinal symptoms, should be included in the differential diagnostic list of symptoms of Crohn's disease