The clinical observation that Coronavirus disease (COVID)-19 can affect various organs has recently been attributed to SARS-CoV-2 infection of endothelial cells leading to endothelialitis and microvascular coagulation. We extend this knowledge by showing pathological findings from a bowel specimen. A previously healthy, 43-year-old male developed flu-like symptoms after SARS-CoV-2 contact. Two weeks later, he presented with respiratory failure requiring endotracheal intubation, mechanical ventilation and extracorporeal membrane oxygenation. The clinical course was protracted with slow recovery of pulmonary function and persistent signs of systemic inflammation. Four weeks after intubation, he developed acute non-obstructive mesenteric ischemia and emergency hemicolectomy was required. Histological examination revealed severe endothelialitis and multiple microthrombi in particular in the venous vascular bed (arrows in Fig. 1a). Electron microscopy showed multiple SARS-CoV-2 viral particles in the large bowel endothelium (Fig. 1b)—which is well-known for its higher than average expression of the entry receptor ACE-2. Of note, non-obstructive bowel necrosis has been increasingly recognized as an emerging complication of severe COVID-19. It strikes us that we found abundant and seemingly intact viral particles in the bowel endothelium about 8 weeks after initial infection when the virus was already undetectable in respiratory and blood specimens.
SD is supported by Deutsche Forschungsgemeinschaft (DE) (Grant number DA 1209/4-3).
Open access funding provided by University of Zurich Open access funding provided by University of Zurich.
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Stahl, K., Bräsen, J.H., Hoeper, M.M. et al. Direct evidence of SARS-CoV-2 in gut endothelium. Intensive Care Med 46, 2081–2082 (2020). https://doi.org/10.1007/s00134-020-06237-6