Microthrombosis Associated with Gastrointestinal Bleeding in
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A 35-year-old man with sickle-cell trait and diabetes status post-renal transplantation presented with weeks of episodic severe cramping, abdominal pain, diarrhea, maroon stool, and anorexia despite empiric antibiotics for gastroenteritis. Presentation laboratory results noted a mild leukocytosis and a hemoglobin of 6.4 g/dL. Nasopharyngeal RT-PCR for SARS CoV-2 was positive despite lack of respiratory symptoms or fever. CT scan demonstrated diffusely thickened stomach and small-bowel walls.

Upper endoscopy revealed normal gastric mucosa but edematous, friable duodenal mucosa with contact bleeding. Duodenal mucosal biopsies demonstrated hemorrhage in the lamina propria with fibrin microthrombi. A biopsy of a small gastroesophageal junction polyp incidentally showed dysplasia with a focus of adenocarcinoma. Magnetic resonance angiography failed to show any explanatory large vessel disease.

His melena resolved 4 weeks after symptom onset and 3 blood transfusions.Repeat endoscopy at 5 weeks showed normal mucosa; the polyp was successfully removed en-bloc by submucosal dissection. No other thromboses were noted during his course; d-dimer peaked at 1633 mg/mL. Gastrointestinal involvement of SARS-CoV-2 is common; typical symptoms include diarrhea and nausea, although bleeding has been rarely described. This is the first endoscopic description of biopsy-confirmed COVID-19 associated microthrombosis, reinforcing the importance of endoscopy with adequate biopsy.

Source: https://www.giejournal.org/article/S0016-5107(20)34561-2/fulltext?rss=yes
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