Case

Reference

Patient Age (y)

Patient Sex

Clinical characteristics

GI pathology findings

Additional investigations

Treatment

Outcome

1

9, 10

78

M

- Patient presented with cough and fever for 7 days.

- HD 1: fever, stable vital signs, SaO₂ > 95%; positive SARS-CoV2 rRT-PCR testing of nasopharyngeal and oropharyngeal swab specimens; multiple ground-glass opacities in both lungs on chest CT.

- HD 4: severe respiratory distress; decreased PaO₂/FiO₂ (130); extensive bilateral consolidation on chest X-ray.

- HD 10: upper GI bleeding; mainly esophageal mucosal lesions on endoscopy; biopsy samples were taken from esophagus, gastric, duodenum and colon.

No significant damage: occasional lymphoplasmacytic

inflammation and edema in the esophageal

mucosa, gastric lamina propria, duodenal and rectal mucosae.

IFL: ACE2+ NP+

in gastric, duodenal, and rectal epithelial cell; weak expressions in the esophageal mucosa.

Empiric antimicrobials, oseltamivir, moxifloxacin, intubation, MV, V-V-ECMO.

- Stable vital signs with mechanical ventilation, V-V-ECMO and low dose vasopressors on HD 26.

- No obvious evidence of other organs dysfunction.

2

16

NA

NA

- Patient admitted for rectal adenocarcinoma, underwent surgical resection.

- POD3: fever and cough.

- POD7: throat swab samples tested positive for SARS-CoV2 by qRT-PCR; bilateral ground-glass opacities of subpleural lung parenchyma.

- POD14: ground-glass opacities, consolidation, irregular linear fibrosis, irregular fibrosis foci.

No significant mucosal damage: abundant lymphocytes and macrophages infiltrating the lamina propria.

Electron microscopy: SARS-CoV-2 virions in the rectal tissue

qRT-PCR detected SARS-CoV-2 nucleic acid in the rectal specimens

IHC: NP+ on intestinal epithelial cells, lymphocytes and macrophages in the lamina propria.

NA

- POD41: Patient was discharged after 2 consecutive negative qRT-PCR test results and absence of clinical symptoms and radiological abnormalities.

- POD72: throat and rectal swab samples tested negative for SARS-CoV-2 nucleic acid.

3

11

69

M

- Patient with hypertension admitted with respiratory failure.

- Reduced left ventricular ejection fraction on echocardiography.

- Circulatory collapse ensued with mesenteric ischaemia and small intestine resection was performed.

Prominent endothelitis of small intestine submucosal vessels and apoptotic bodies.

IHC: ACE2+ on endothelial cells

NA

Patient survived.

4

13

67

M

- Obese patient, T2DM, hypertension, hyperlipidemia, left bundle branch block.

- Fever and chill for 8 days, cough and shortness of breath for 3 days.

- Nasal swab positive testing for SARS-CoV-2 and methicillin-susceptible staphylococcus aureus.

- Respiratory failure followed by multi-organ failure.

- HD 33: lower GI bleeding, scattered erosions and ulceration on colonoscopy.

Nonspecific acute inflammation, ischemic pattern of injury.

IHC: negative staining for CMV

Multiple medication, anticoagulants, antibiotics, antifungal agents, transfusion, intubation.

- HD 49: GI bleeding resolved spontaneously, patient was discharged.

5

13

68

M

- Obese patient, tobacco addiction, T2DM, hypertension, hyperlipidemia, CHD.

- Cough, fever, diarrhea and altered mental status for 5 days.

- Nasal swab positive testing for SARS-CoV-2 by PCR.

- Respiratory failure followed by multi-organ injury.

- HD 40: lower GI bleeding, normal bowel caliber with no evidence of obstruction on CT abdomen pelvis, colonoscopic appearance clinically consistent with ischemic colitis.

Focal edema, mildly active nonspecific inflammation.

NA

Multiple medication, anticoagulants, antibiotics, antifungal agents, transfusion, intubation.

- HD 54: GI bleeding resolved spontaneously, patient was admitted to the rehabilitation unit.

6

Present case

62

M

- Patient presented with nausea and epigastric pain with back irradiation for 2 weeks.

- Absence of comorbidity or clear exposure history with COVID-19.

- Stable clinical course on presentation.

- HD 2: subfebrile fever, vomiting, diarrhea, persistent and severe epigastric pain, elevated serum lipase, no evidence of acute pancreatitis on CT imaging, normal electrocardiogram.

- Upper GI endoscopy: rugged appearance of the duodenum.

- Nasal swab positive testing for SARS-CoV-2 by GeneXpert.

- Preserve villus height, epithelial dystrophy and denudation.

- Marked inflammation in the lamina propria that focally causes glandular damage.

- Cytopathic viral effects in residual glands: enlarged cells, vacuolated or ballonised cytoplasm, large smudged nuclei, intranuclear inclusions.

- Numerous microthrombi, ACE2 + on various enterocytes.

None

Azithromycin, anticoagulant, analgesic, antidiarrheal.

- HD 17: overall clinical condition improved.

- HD 22: discharge.