Peculiar Histopathological Alterations of Enterocytes in A Coronavirus Disease 2019 Patient with Mycobacterial Tuberculosis Co-Infection

Abstract

\n Background: The ongoing novel Coronavirus Disease 2019 (COVID-19) pandemic is principally defined by its respiratory symptoms. While it is clear that the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) can affect the gastrointestinal tract (GIT) and the pathogenesis of coronavirus disease 2019 is better understood, the exact pathological alterations following infection require further investigation. The purpose of this paper is to report and share our histopathological findings from a right hemicolectomy specimen of a confirmed COVID-19 positive case, which exhibited a Mycobacterium Tuberculosis co-infection.Methods:Microscopic sections from right hemicolectomy specimen were appropriately stained and studied by two anatomical pathologists. Additionally, we searched PubMed and Google Scholar databases for reports/observations regarding pathological alterations of the intestine following COVID-19 infection.Results:Histological sections showed novel peculiar pathological alterations in the terminal ileal mucosa involving principally absorptive enterocytes with evidence of striking cellular injury as well as prominent erythrophagocytosis in the mesenteric lymph nodes. No specific pathological alterations were observed in the appendix or colon. The characteristic pathological features of Mycobacterium Tuberculosis infection were also observed throughout the specimen.Conclusions:Our observations showed that the novel SARS-CoV-2 can affect the gastrointestinal tract, causing epithelial injury and pathological alterations attributed to its ability to infect absorptive enterocytes by interacting with the Angiotensin Converting Enzyme-2 (ACE2) receptor. These pathological findings could be regarded as viral cytopathic changes and should be considered when evaluating gastrointestinal specimens from COVID-19 infected patients.