COVID-19 infection in Crohn's disease under treatment with adalimumab

A 30-year-old male was admitted on emergency department of the Bari University Hospital, Puglia Region, Southern Italy, on 12 March 2020 (with a low number of cases until that date) due to sudden occurrence of fever (38°C) associated with chest pain during breaths. He underwent to oral and nasal specimens, which resulted positive for COVID-19, and he was admitted to infectious disease division. He was affected from ileal Crohn’s disease (CD), and was under treatment with mesalazine 3 g/day and adalimumab 40 mg subcutaneously every other week for 5 years due to steroid dependency. He was under sustained remission for 2 years, and no other comorbidities was reported. At entry, he needed just oxygen support; thoracic CT scan showed mild interstitial inflammation and laboratory examination (including erythrocyte sedimentation rate and C reactive protein) was normal except for a mild thrombocytopenia (1643/μL, n.v. 179–3733/μL). No abdominal pain was reported, and bowel movements were normal. Any specific therapy was started except for suspension of adalimumab, and he had a rapid clinical improvement: fever and chest pain disappeared within 24 hours, and at the fifth day of hospital stay he was asymptomatic (an Rx of the chest did not find sign of inflammation at that time). Significantly, no occurrence of abdominal pain or changes in bowel habits were recorded, and also faecal calprotectin assessment was normal (38 mg/kg, n.v. <50 mg/kg).