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Unusual case of severe diarrhoea
  1. Genki Inoue1,2,
  2. Shuji Yamamoto1,
  3. Nobuo Koh1,
  4. Takeshi Kuwada1,
  5. Yuki Nakanishi1,
  6. Ken Takahashi1,
  7. Hiroshi Seno1
  1. 1Department of Gastroenterology and Hepatology, Kyoto University, Kyoto, Japan
  2. 2Department of Gastroenterology and Hepatology, Nishikobe Iryo Center, Kobe, Hyogo, Japan
  1. Correspondence to Dr Shuji Yamamoto, Department of Gastroenterology and Hepatology, Kyoto University, Kyoto 606-8507, Japan; shuyama{at}

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A 56-year-old man with COVID-19 pneumonia, requiring mechanical ventilation and extracorporeal membrane oxygenation, was transferred to our hospital. He was successfully treated with dexamethasone and remdesivir, followed by favipiravir, and he was extubated on day 30. Eighteen days after admission, he developed severe watery diarrhoea (passing more than 7000 mL/day). Subsequently, he went into shock due to hypovolaemia and hypoalbuminaemia (2.3 g/dL), and norepinephrine and albumin administration were commenced. Contrast-enhanced CT showed thickening of the small and large intestinal walls without findings suggesting intestinal ischaemia, such as decreased bowel wall enhancement and mesenteric thrombosis (figure 1A). Sigmoidoscopy on day 32 (figure 1B) showed prominent detachment of the colonic mucosa, and peroral enteroscopy …

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  • Contributors Conception: GI and SY. The patients’ physician: GI, SY, NK, TK, YN and KT. Analysis and interpretation of the data: GI and SY. Drafting of the article: GI and SY. Critical revision of the article for important intellectual content: SY, TK, YN, KT and HS. Final approval of the article: GI, SY, NK, TK, YN, KT and HS.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.