Open AccessGastrointestinal Pathology in Samples From Coronavirus Disease 2019 (COVID-19)–Positive Patients
Author(s) -
Maria Westerhoff,
Dan Jones,
Steven Hrycaj,
May P. Chan,
Liron Pantanowitz,
Huolin Tu,
Karen Choi,
Joel Greenson,
Laura Lamps
Publication year - 2021
Publication title -
archives of pathology and laboratory medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.79
H-Index - 117
eISSN - 1543-2165
pISSN - 0003-9985
DOI - 10.5858/arpa.2021-0137-sa
Subject(s) - medicine , ulcerative colitis , in situ hybridization , coronavirus , histopathology , context (archaeology) , gastroenterology , pathology , covid-19 , disease , biology , gene expression , infectious disease (medical specialty) , gene , paleontology , biochemistry
Context.— Although primarily considered a respiratory illness, coronavirus disease 2019 (COVID-19) can cause gastrointestinal manifestations. Objective.— To evaluate histopathology and in situ hybridization for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in gastrointestinal samples from patients with recent and remote COVID-19. Design.— Patients with positive SARS-CoV-2 nasopharyngeal tests and a gastrointestinal tissue specimen were included. SARS-CoV-2 in situ hybridization (ISH) was performed on each sample. A subset had SARS-CoV-2 next-generation sequencing (NGS) performed. Results.— Twenty-five patients met inclusion criteria. Five had positive SARS-CoV-2 nasopharyngeal tests within 7 days of their gastrointestinal procedure. Two were ulcerative colitis patients on steroid therapy who lacked typical COVID-19 symptoms. Their colectomies showed severe ulcerative colitis; one demonstrated SARS-CoV-2 by NGS but a negative ISH. Another had an ischemic colon resected as a complication of the COVID-19 course; however, both ISH and NGS were negative. A fourth had a normal-appearing terminal ileum but positive ISH and NGS. The fifth patient had ileal ulcers with SARS-CoV-2 negativity by both modalities. The remaining 20 patients had positive nasopharyngeal tests an average of 53 days prior to procedure. None of their samples demonstrated SARS-CoV-2 ISH positivity, but one was positive on NGS despite a negative nasopharyngeal test. Conclusions.— Gastrointestinal findings from SARS-CoV-2–infected patients ranged from normal with virus detected by ISH and NGS to bowel ischemia secondary to systemic viral effects without evidence of virus in the tissue. No distinct histologic finding was identified in those with gastrointestinal tissue specimens demonstrating SARS-CoV-2 positivity in this cohort.