Intestinal Abnormalities in Patients With SARS-CoV-2 Infection: Histopathologic Changes Reflect Mechanisms of Disease
Abstract
Approximately 20% of patients with symptomatic syndrome-associated coronavirus-2 (SARS-CoV-2) infection have gastrointestinal bleeding and/or diarrhea. Most are managed without endoscopic evaluation because the risk of practitioner infection outweighs the value of biopsy analysis unless symptoms are life-threatening. As a result, much of what is known about the gastrointestinal manifestations of coronavirus disease-2019 (COVID-19) has been gleaned from surgical and autopsy cases that suffer from extensive ischemic injury and/or poor preservation. There are no detailed reports describing any other gastrointestinal effects of SARS-CoV-2 even though >3,000,000 people have died from COVID-19 worldwide. The purpose of this study is to report the intestinal findings related to SARS-CoV-2 infection by way of a small case series including one with evidence of direct viral cytopathic effect and 2 with secondary injury attributed to viral infection. Infection can be confirmed by immunohistochemical stains directed against SARS-CoV-2 spike protein, in situ hybridization for spike protein-encoding RNA, and ultrastructural visualization of viruses within the epithelium. It induces cytoplasmic blebs and tufted epithelial cells without inflammation and may not cause symptoms. In contrast, SARS-CoV-2 infection can cause gastrointestinal symptoms after the virus is no longer detected, reflecting systemic activation of cytokine and complement cascades rather than direct viral injury. Reversible mucosal ischemia features microvascular injury with hemorrhage, small vessel thrombosis, and platelet-rich thrombi. Systemic cytokine elaboration and dysbiosis likely explain epithelial cell injury that accompanies diarrheal symptoms. These observations are consistent with clinical and in vitro data and contribute to our understanding of the protean manifestations of COVID-19.
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Non-occlusive mesenteric ischemia in patients hospitalized in intensive care units for SARS-CoV-2 pneumonia requiring vasopressor medication may be caused by vasospastic constriction.
“Non-occlusive mesenteric ischemia in patients hospitalized in intensive care units for SARS-CoV-2 pneumonia requiring vasopressor medication may be caused vasospastic constriction [19,64,65].”
From Acute mesenteric ischemia in COVID-19 patients (2021) · cites this paper as [65]
Acute arterial obstruction of the small intestinal vessels and mesenteric ischemia may appear due to hypercoagulability associated with SARS-CoV-2 infection, mucosal ischemia, viral dissemination, and endothelial cell invasion via ACE-2 receptors.
“Acute arterial obstruction of the small intestinal vessels and mesenteric ischemia may appear due to hypercoagulability associated with SARS-CoV-2 infection, mucosal ischemia, viral dissemination, and endothelial cell invasion vis ACE-2 receptors [65,66].”
From Acute mesenteric ischemia in COVID-19 patients (2021) · cites this paper as [65]
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Acute mesenteric ischemia in COVID-19 patients
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- Authors
- Yantiss, R. K., Qin, L., He, B., Crawford, C. V., Seshan, S., Patel, S., Wahid, N., & Jessurun, J.
- Affiliations
- Department of Pathology and Laboratory Medicine
- Weill Cornell Medicine (US)
- NewYork–Presbyterian Hospital (US)
- Corresponding author
- Yantiss, Rhonda K.
- Qin, LiHui
- He, Bing
- Seshan, Surya
- Patel, Sanjay
- Venue
- American Journal of Surgical Pathology
- Published
- 2021-06-03
- Volume
- 46
- Issue
- 1
- Pages
- 89-96
- ISSN
- 0147-5185 (ISSN-L)
- OpenAlex
- W3165662408
- Cited by
- 23
- References
- 24
- Citations by year
- 2026: 2 · 2024: 4 · 2023: 5 · 2022: 10 · 2021: 2
- FWCI
- 1.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Surgical Pathology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Dermatology › Dermatological and COVID-19 studies
- Keywords
- SARS-CoV-2, COVID-19 pandemic, gastrointestinal manifestations, cytopathic effect, diarrhea, gastrointestinal bleeding, SARS-CoV-2 spike protein, virus ultrastructure, cytokine activation, dysbiosis, epithelial damage, small vessel thrombosis
- MeSH terms
- COVID-19, Adult, Aged, Aged, 80 and over, Biopsy, Gastrointestinal Hemorrhage, Humans, Intestinal Diseases, Intestines, Ischemia, Male, Thrombosis, Biomarkers, Cytokines
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