Terminal Ileitis as the Exclusive Manifestation of COVID-19 in Children

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-C...

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Bibliographic Details
Published in:	Microorganisms (Basel) Vol. 12; no. 7; p. 1377
Main Authors:	Schuler, Lea Maria, Falkensammer, Barbara, Orlik, Peter, Auckenthaler, Michael, Kranewitter, Christof, Bante, David, von Laer, Dorothee, Fink, Franz-Martin
Format:	Journal Article
Language:	English
Published:	Switzerland MDPI AG 06-07-2024
Subjects:	Abdomen ACE2 Adenoviruses Angiotensin Angiotensin-converting enzyme 2 Antibiotics Appendicitis C-reactive protein Campylobacter Case reports Children Chronic illnesses Concurrent infection COVID-19 Diarrhea Differential diagnosis Enterocolitis Fever Gastrointestinal system Gastrointestinal tract Ileitis Ileum Immunoglobulins Infections Infectious diseases Inflammation Inflammatory bowel disease Inflammatory diseases Influenza Lymphadenitis Lymphatic system Multisystem inflammatory syndrome in children nucleic acid amplification Nucleic acids Oxford nanopore technology Pain Pathogens Pediatrics Peptidyl-dipeptidase A Procalcitonin Salmonella SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 Small intestine terminal ileitis Ultrasonic imaging Viral diseases Young adults United Kingdom > UK COVID-19 terminal ileitis SARS-CoV-2 nucleic acid amplification children Oxford nanopore technology
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Summary:	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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2076-2607 2076-2607
DOI:	10.3390/microorganisms12071377