We present a case of a male patient in his mid-30s with COVID-19-induced lung failure requiring
extracorporeal membrane oxygenation, who needed an emergency oesophagogastroduodenoscopy due to major upper gastrointestinal
bleeding. Endoscopy exposed severe ulcerative
duodenitis with diffuse mucosal
bleeding. While CT angiography did not show any signs of ischaemia, histopathology revealed
duodenitis with substantial inflammatory cell infiltrates consisting of neutrophils and CD3+ T lymphocytes with equal CD4+/CD8+ distribution. Since the composition of cell infiltrates coincides with changes in inflammatory patterns of the respiratory mucosa from patients with
COVID-19 and in COVID-19-associated
enterocolitis, and systemic
dexamethasone treatment became standard of care in ventilated intensive care unit patients with
COVID-19 infection, we initiated an individualised therapeutic attempt to treat the
duodenitis with topical enteral
budesonide. Follow-up oesophagogastroduodenoscopies within 4 weeks of enteral
budesonide administration revealed a full clinical and histological healing of the duodenal mucosa with marked reduction of neutrophilic and lymphocytic infiltrates.To our knowledge, the current report is the first description of enteral
budesonide treatment of
duodenitis in a patient with
COVID-19 infection and warrants further investigation, whether
budesonide might constitute a novel therapeutic strategy for the management of COVID-19-related intestinal mucosal damage.