Terminal Ileitis as the Exclusive Manifestation of COVID-19 in Children.

Publication date: Jul 06, 2024

The clinical presentation, organ involvement, and severity of disease caused by SARS-CoV-2 are highly variable, ranging from asymptomatic or mild infection to respiratory or multi-organ failure and, in children and young adults, the life-threatening multisystemic inflammatory disease (MIS-C). SARS-CoV-2 enters cells via the angiotensin-converting enzyme-2 receptor (ACE-2), which is expressed on the cell surfaces of all organ systems, including the gastrointestinal tract. GI manifestations have a high prevalence in children with COVID-19. However, isolated terminal ileitis without other manifestations of COVID-19 is rare. In March 2023, two previously healthy boys (aged 16 months and 9 years) without respiratory symptoms presented with fever and diarrhea, elevated C-reactive protein levels, and low procalcitonin levels. Imaging studies revealed marked terminal ileitis in both cases. SARS-CoV-2 (Omicron XBB. 1.9 and XBB. 1.5 variants) was detected by nucleic acid amplification in throat and stool samples. Both patients recovered fast with supportive measures only. A differential diagnosis of acute abdominal pain includes enterocolitis, mesenteric lymphadenitis, appendicitis, and more. During SARS-CoV-2 epidemics, this virus alone may be responsible for inflammation of the terminal ileum, as demonstrated. Coinfection with Campylobacter jejuni in one of our patients demonstrates the importance of a complete microbiological workup.

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Concepts	Keywords
Lymphadenitis	children
Microbiological	COVID-19
Organ	nucleic acid amplification
Young	Oxford nanopore technology
	SARS-CoV-2
	terminal ileitis

Semantics

Type	Source	Name
disease	MESH	Terminal Ileitis
disease	MESH	COVID-19
disease	VO	organ
disease	MESH	infection
drug	DRUGBANK	Angiotensin II
disease	IDO	cell
disease	MESH	enterocolitis
disease	MESH	mesenteric lymphadenitis
disease	MESH	appendicitis
disease	MESH	inflammation
disease	MESH	Coinfection
disease	MESH	asymptomatic infection
disease	VO	organization
disease	MESH	emergency
disease	MESH	syndrome
disease	MESH	pediatric inflammatory multisystem syndrome
disease	MESH	myocarditis
drug	DRUGBANK	Coenzyme M
disease	MESH	long COVID
disease	MESH	joint pain
disease	MESH	chronic disease
disease	MESH	ileitis
disease	MESH	ulcerative colitis
disease	MESH	spondyloarthropathies
disease	MESH	vasculitides
disease	MESH	gastroenteritis
disease	IDO	history
disease	VO	erythrocyte
disease	IDO	blood
drug	DRUGBANK	Chloride ion
drug	DRUGBANK	Human Serum Albumin
disease	MESH	acute phase reaction
disease	VO	protocol
disease	MESH	infectious diseases
disease	IDO	pathogen
disease	IDO	assay
disease	MESH	Influenza
disease	VO	Viruses
disease	MESH	Parainfluenza
disease	VO	vaccinated
disease	MESH	lymphadenopathy
disease	VO	Respiratory syncytial virus
disease	MESH	leukocytosis
disease	VO	time
disease	MESH	tachycardia
disease	MESH	cecitis
drug	DRUGBANK	Apomorphine
disease	MESH	laboratory infection
drug	DRUGBANK	L-Valine
disease	MESH	edema
disease	MESH	lymphadenitis
drug	DRUGBANK	Immune Globulin Human
disease	MESH	colitis
disease	MESH	enteritis
disease	IDO	host
drug	DRUGBANK	Phenobarbital
disease	MESH	viral shedding
disease	MESH	dysbiosis
disease	IDO	immune response
disease	VO	Bacteria
disease	VO	Primates
disease	MESH	Pneumonia
drug	DRUGBANK	(S)-Des-Me-Ampa
drug	DRUGBANK	Carboxyamidotriazole
disease	MESH	Allergy
drug	DRUGBANK	Minaprine
disease	VO	frequency
disease	MESH	Clinical Significance
disease	MESH	hyperplasia
disease	VO	report
disease	MESH	Sepsis
disease	MESH	Pancreatitis
drug	DRUGBANK	Guanosine

Original Article

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