• Marouf Alhalabi, Kamal Alaa Eddin, Fadwa Ali, and Ahmad Abbas.
• Gastroenterology Department of Damascus Hospital, Damascus, Syria.
• Medicine (Baltimore). 2022 Jan 28; 101 (4): e28722e28722.

RationaleThe ongoing coronavirus pandemic has caused severe acute respiratory syndrome, posing a significant challenge for patients receiving immunotherapy for immune-mediated inflammatory diseases. As of January 2022, immunosuppressants such as tumor necrosis factor inhibitors (anti-TNFα) and azathioprine are inadvisable for an infectious disease caused by the SARS-CoV-2 virus (COVID-19). We continued infliximab as a second induction dose nine days after the onset of COVID-19 symptoms in a patient with acute severe ulcerative colitis.Patient ConcernsWe report the case of a 34-year-old male with 6 to 8 times bloody diarrhea, fever, and cramping abdominal pain. Ulcerative colitis was diagnosed 6 months earlier and treated with mesalamine 80 mg/kg/day and azathioprine 2.5 mg/kg/day. The patient had never undergone surgery before. Sigmoidoscopy revealed multiple ulcerations and spontaneous bleeding, and the colon samples tested negative for cytomegalovirus and Clostridium difficile. However, intravenous corticosteroids did not induce remission. A nasopharyngeal swab tested positive for SARS-CoV-2.DiagnosisAcute severe ulcerative colitis and SARS-CoV-2 (COVID-19) pneumonia.InterventionsThe second loading dose of infliximab was administered nine days after the diagnosis of COVID-19.OutcomeThe patient completed infliximab induction at a dose of 5 mg/kg at weeks 0, 2, and 6, with no complications.LessonsIt is unclear whether anti-TNF-α treatment improves or deteriorates COVID-19 patient outcomes, and this case demonstrates that infliximab can be used safely. Current guidelines make a weak recommendation to avoid using anti-TNFα agents in the presence of acute COVID-19 infection. There is an urgent need for research on biologics therapy.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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