Newly diagnosed Crohn's Disease after COVID-19 Infection: A Case Report

Abstract

Viral infections are recognized as potential triggers for immune-mediated diseases, and an increasing number of reports have described newly diagnosed inflammatory bowel disease (IBD) following COVID-19. We report a previously healthy 23-year-old man who was diagnosed with Crohn’s disease (CD) shortly after symptomatic SARS-CoV-2 infection. Within two weeks of the confirmed infection, he developed severe gastrointestinal symptoms, followed by a perianal abscess and fistulizing disease. Ileocolonoscopy revealed patchy erosive colitis with predominant rectosigmoid involvement, while histological examination demonstrated chronic active granulomatous ileocolitis. He required surgical drainage, corticosteroids, azathioprine, and ultimately infliximab, achieving complete mucosal healing within one year. A literature review identified 19 previously reported cases of newly diagnosed IBD following COVID-19, most of which were ulcerative colitis; none of the reported CD cases presented with perianal fistulizing disease or required anti-TNF therapy. Proposed pathophysiological links between COVID-19 and IBD include altered epithelial ACE2 expression, gut dysbiosis, barrier disruption, and post-infectious immune dysregulation, providing biological plausibility for a possible association. This rare case of severe, newly diagnosed CD temporally associated with COVID-19 highlights the need to investigate persistent gastrointestinal symptoms after infection, although causality and the possibility of previously subclinical disease cannot be established from a single case.