South Korean Physicians Warn That COVID-19 Infections Can Trigger Gastrointestinal AA Amyloidosis
COVID-19 News: The SARS-CoV-2 pandemic has been one of the most challenging global health crises in recent history as seen in various
COVID-19 News reports over the last three and a half years. As researchers and medical professionals around the world strive to understand the virus and its potential long-term effects, a group of South Korean physicians from Chonnam National University Medical School has raised an important concern. They warn that COVID-19 infections may trigger gastrointestinal AA amyloidosis, a rare and serious disorder affecting the GI tract. The physicians recently reported a case of a 75-year-old male who developed GI AA amyloidosis following SARS-CoV-2 reinfection, highlighting the need for vigilance in managing post-COVID-19 complications.
Esophagogastroduodenoscopy (EGD). Pre-transplant EGD showed no specific abnormal
findings in the stomach (A). On the day 30 of hospitalization, EGD showed friable mucosa
with newly observed multiple, small-round coalesced ulcers in the lower body and stomach
antrum (B). Follow-up EGD at 2 weeks revealed improvement in the mucosal lesions
of the stomach (C).
Understanding Gastrointestinal AA Amyloidosis
Amyloidosis is a group of rare diseases characterized by the abnormal deposition of proteins known as
amyloids in various organs. Gastrointestinal AA amyloidosis is a specific form of the disorder where amyloid proteins accumulate in the gastrointestinal tract, causing interference with its structure and function. The two most common types of amyloidosis are light chain (AL) and secondary (AA) amyloidosis. While AL amyloidosis is linked to plasma cell production of misfolded amyloidogenic light chains, AA amyloidosis results from chronic inflammations, infections, or
neoplasms.
The Case Report
In the reported case, a 75-year-old male with a history of polycythemia vera, diabetes, and a recent kidney transplantation presented to the emergency department with upper abdominal pain. The patient had undergone a living-donor kidney transplantation six weeks before his symptoms appeared. Notably, he had also tested positive for SARS-CoV-2 infection four weeks prior to the presentation. While receiving conservative management for his abdominal pain, the patient experienced a reinfection of SARS-CoV-2, exhibiting symptoms of cough and fever on day 7 of hospitalization.
As his abdominal pain persisted, the patient developed hematochezia (passing blood through the rectum) on day 30 of hospitalization.
Esophagogastroduodenoscopy (EGD) and colonoscopy were performed, revealing multiple ulcers in the stomach and colon. The histologic examination confirmed the presence of amyloid A in the gastrointestinal tissues. Subsequent testing s
uggested a diagnosis of GI AA amyloidosis.
Managing GI AA Amyloidosis Following SARS-CoV-2 Infection
The treatment and management of amyloidosis depend on the underlying cause of the amyloid deposition. In this case, as the patient's amyloidosis was secondary to chronic inflammation caused by SARS-CoV-2 infection, controlling the inflammatory response was crucial. The patient received remdesivir for the SARS-CoV-2 infection, which eventually led to an improvement in both his clinical symptoms and endoscopic findings, demonstrating a positive response to treatment.
Prognosis and Implications
The prognosis of GI AA amyloidosis varies based on factors such as the extent and severity of amyloid deposition, the underlying cause, and the presence of associated conditions. The patient in this case is expected to have a relatively favorable prognosis, considering that his amyloidosis was limited to the GI tract without systemic involvement. However, due to his age and comorbidities, including hypertension, diabetes, and chronic kidney disease, regular follow-up and conservative management are recommended.
Conclusion
This case of gastrointestinal AA amyloidosis following SARS-CoV-2 reinfection sheds light on a potential subacute complication that may arise in immunocompromised patients recovering from COVID-19. The study underscores the importance of vigilant monitoring and careful consideration of differential diagnoses in patients experiencing atypical gastrointestinal symptoms after COVID-19 infection.
The study findings were published in the peer reviewed Yonsei Medical Journal.
https://eymj.org/DOIx.php?id=10.3349/ymj.2022.0636
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https://www.thailandmedical.news/news/breaking-news-researchers-find-that-covid-19-infections-and-even-covid-19-vaccines-can-induce-amyloidosis
https://www.thailandmedical.news/news/breaking-university-of-oklahoma-study-indicates-that-sars-cov-2-might-cause-serum-amyloid-a-saa-amyloidosis-and-even-alzheimer-ultimately
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