P019  Covid-19 infection in a patient with Crohn`s disease under treatment with ustekinumab - Case Report

P019  Covid-19 infection in a patient with Crohn's disease under treatment with ustekinumab - Case Report

 

Almeida Clarissa1, Maluf Fauze1, Fachin Adriano2, Almeida Maristela2
1 Faculdade de Medicina do ABC, Santo André, Brazil, 2 Professor Edmundo Vasconcelos Hospital, São Paulo, Brazil

CASE: We report a case of a 44-year-old patient with ileocolonic Crohn's disease, infected with SARS-Cov-2 and, on treatment with ustekinumab for six months. The patient has been treated for Crohn's disease since 2002. Ustekinumab was prescribed after the failure of treatment with infliximab and adalimumab six months ago. In May 2020, she presented headache, coryza, general malaise, and a temperature of 37.7oC, which persisted for two days. She sought an emergency room for investigation and presented the following lab tests results: Hb=14.9g/dl; Ht=44%; Total leucocytes=8400/mm3; Lymphocytes= 15% ( normal range 20-45%); Platelets count= 357.000/mm3; CPR= 20mg/L (normal value < 500ng/mL), oxygen saturation = 97%. Chest tomography showed ground-glass peripheral pulmonary opacities with impairment of less than 25%. Given Covid-19 suspicious, rt-PCR for SARS-Cov-2 was collected and the result was positive. She was discharged to her home with symptomatic pills and azithromycin 500mg/day for 5 days. In the following days, she presented diarrhea (8x/day), nausea, vomiting, and returned to the emergency room for intravenous medication and hydration. After this treatment, she was discharged again to her home. There was an improvement in symptoms, but diarrhea persisted for 8 days. The next maintenance dose of ustekinumab was suspended for 15 days. After this period, she collected a control rt-PCR for SARS-Cov-2 that resulted negative and, returned to use biologic therapy without presenting any complication. In this case, there was a good recovery of Covid-19 even during the use of ustekinumab. The possibility of performing rt-PCR and monitoring signs and symptoms of the disease, allowed the period of active infection to be properly controlled. Additionally, biological therapy could also be promptly resumed without jeopardizing the treatment of Crohn's disease.