SARS-CoV-2 Gastrointestinal Infection Causing Hemorrhagic Colitis: Implications for Detection and Transmission of COVID-19 Disease

ow naded rom httpsournals.lw w om ajg by hD M fePH KazEoum tQ fN 4a+khEZgbsIH o4XM hC yw C X1AW YQ /IlQ rH D 3k+bD uTnm YSqiBLfobZQ C jO ksJO piYcXLVm 9M nqVw Ac+G P+cQ == on 083/2020 Downloadedfromhttps://journals.lww.com/ajgbyBhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD38k+bDukTnmYSqB9iBLfobZQCjOkIsJOpiY9cXLVm9MnqVwAc+GP+cQ==on08/23/2020 infection control measures, symptomatic treatment, and supportive care including supplemental oxygen and mechanical ventilation when appropriate. There are currently no approved therapies to treat COVID-19 infection. Clinical trials are ongoing to evaluate antiviral therapies and immune-modulator therapies. The antimalarial and anti-inflammatory medication, hydroxychloroquine, has been widely used to treat COVID-19 infection without any available data from randomized clinical trials to inform clinical guidance on the use, dosing, or duration of hydroxychloroquine for prophylaxis or the treatment of COVID-19 infection (3). Hydroxychloroquine has been shown to have in vitro activity against SARS-CoV and SARS-CoV-2 (COVID-19) (4). A single, nonrandomized study of 36 patients in France suggested that hydroxychloroquine lowered coronavirus levels in the blood as compared to untreated controls and shortened recovery time (5). Six of the 20 patients who received hydroxychloroquine also received azithromycin, whereas none of the control received azithromycin. A randomized study from China reported that hydroxychloroquine showed no benefit in treating COVID-19 infection (6). Hydroxychloroquine is currently under investigation in clinical trials for pre-exposure or postexposure prophylaxis of COVID-19 infection and treatment of patients with mild, moderate, and severe COVID-19. On review of the limited literature to date, our case appears tobe thefirst reported case of COVID-19 infection presenting as acute hepatitis before the development of respiratory symptoms. Clinicals should be aware in this era of COVID-19 infection that acute nonicteric hepatitis may be the virus’ initial presentation before the development of respiratory symptoms. Patients with risk factors for COVID-19 presenting with acute hepatitis should be isolated and undergo testing for COVID19.Further observational studies areneeded to determine the frequency of this presentation and that of mild-to-moderate liver test abnormalities during this evolving pandemic.