A complicated case of terminal ileitis post-COVID-19 infection requiring bowel resection

Since the beginning of the COVID-19 pandemic, there have been reports of children developing systemic hyperinflammatory response to COVID-19 infection, known as Paediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-COV-2 (PIMS-TS). Here we would like to discuss a case of a 15-year-old male with PIMS-TS presenting as complicated terminal ileitis, requiring ileocaecal resection. Histopathologic findings of the ileocaecal specimen revealed thickened bowel mucosa, with features of granulomatous inflammation similar to Crohn’s disease, without features of intestinal vasculitis or viral particles. His post-operative course was complicated by fresh rectal bleeding, requiring urgent blood transfusion and endoscopy. Source of bleeding was not identified and his bleeding self-resolved. Gut biopsies of the remaining bowel taken during endoscopy were normal. Although this case suggests that the inflammatory process is focal to the terminal ileum with a good short-term prognosis, further follow-up is required to assess for long-term effects and risks of bowel disease.