A New Onset of Ulcerative Colitis post-2nd-breakthrough-COVID-19

A 21-year-old non-smoking Caucasian male with a history of acute pancreatitis but no other medical issues or family history had two doses of the BNT162b2 mRNA COVID-19 vaccine. 


Four months after the second dose he had his first episode of COVID-19. Although not hypoxic, he felt pretty unwell for a week, with a severe cough, fever, generalized body ache, headache, and loss of taste. He received the third dose of the vaccine two months after recovering from COVID.

Nine months after the third dose, he had the second episode of COVID-19, during which he was mildly unwell for three days, recovered, and did not require any anti-viral medication or antibiotics. One week post the second episode of COVID-19, he developed diarrhea and abdominal pain. It then progressed to bloody diarrhea. Ulcerative colitis was diagnosed based on his clinical symptoms, biopsy changes, and the exclusion of other causes. 

There are ten published case reports about the newly diagnosed ulcerative colitis associated with the SARS-CoV-2 infection. The patient's age ranges between 19 and 84. Three were female cases and seven were male cases.

An 84-year-old Hispanic male with a history of bullous emphysematous chronic obstructive pulmonary disease status post-video-assisted thoracic surgery for recurrent pneumothorax, essential hypertension, type 2 diabetes mellitus, abdominal aortic aneurysm, and prior infectious colitis presented with recurrent diarrhea and dysphagia and was incidentally found to be COVID-19 positive. He had two doses of Moderna vaccine, with the last dose eight months prior to presentation. Prior studies have proposed a direct correlation between the severity of coronavirus disease 2019 (COVID-19) and the severity of ulcerative colitis (UC). However, in this case an inverse correlation between asymptomatic COVID-19 causing severe UC was observed. 



REFERENCES

Xia C, Dissanayake J, Badov D. A New Onset of Ulcerative Colitis Post-COVID-19: A Case Report. Cureus. 2023 Mar 16;15(3):e36257. doi: 10.7759/cureus.36257. PMID: 37069864; PMCID: PMC10105639.

Fonseca Mora MC, Abushahin A, Gupta R, Winters H, Khan GM. Severe Ulcerative Colitis as a Complication of Mild COVID-19 Infection in a Vaccinated Patient. Cureus. 2022 Jun 9;14(6):e25783. doi: 10.7759/cureus.25783. PMID: 35812630; PMCID: PMC9270872.



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