lNTRODUCTlON

A 48-year-old woman from Haidian District, Beijing, China was admitted into the gastroenterology department due to abdominal pain accompanied by hematochezia for 1 d.

Individuals encountered a variety of mental health challenges during the COVID-19 pandemic[5].Given the lack of a specific treatment strategy for COVID-19, the development of vaccines against COVID-19 is a milestone. To date, diverse types of vaccines for COVID-19 have been proposed including messenger RNA (mRNA), non-replicating and replicating vectors, inactivated viruses, protein subunits, viral-like particles, DNA vaccines and live attenuated vaccines[6-8]. Two inactivated vaccines,the China National Biotec Group SARS-CoV-2 vaccine and the CoronaVac vaccine (Sinovac Biotech Ltd.,China) have been adopted for mass vaccination within mainland China. Although the inactivated vaccine is well-tolerated in the general population[9], some rare or serious adverse events may occur.We have attempted to present a case of ischemic colitis following the administration of an inactivated vaccine.

CASE PRESENTATlON

Chief complaints

The outbreak of the coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been the most important clinical challenge worldwide since January 2020. While the spread of COVID-19 in China has been effectively controlled, the pandemic has not ceased. To date, COVID-19 has affected more than 128 million individuals causing over 2.8 million deaths worldwide[1]. The COVID-19 pandemic is globally considered as the primary health threat[2].Although the mortality rate of COVID-19 is low, individuals with diabetes or hypertension are at a higher risk of mortality[3,4].

Hypercoagulable states impairing arterial blood supply to the colon potentially induced by the COVID-19 vaccine could be a potential cause of ischemic colitis[16]. Other risk factors for ischemic colitis include atherosclerosis, abdominal vascular disease and autoimmune disease which all can lead to reduced intestinal blood flow. These in turn may give rise to hypercoagulable states such as suffering from malignant tumors, portal hypertension, hematological disease, hypertension, coronary heart disease, diabetes, constipation, cardiogenic embolism, chronic obstructive pulmonary disease and abdominal surgery[17,18]. The medical history of the patient was normal except for a previous diagnosis of hyperlipidemia.

History of present illness

Two doses of inactivated vaccines against COVID-19 were reported to provide a highly effective defense against antibody-dependent infection which is associated with higher efficiency and genetic stability[12]. Several studies have addressed the safety of COVID-19 inactivated vaccines. For instance,Χia

[13,15] performed an interim analysis of two randomized clinical trials and found the most common adverse events, including injection site pain and fever which was experienced within 7 d after the administration of the vaccine, and these adverse events were mild and self-limited. Zhang

[14]conducted a phase 1/2 clinical trial on healthy adults who were aged 18-59-years-old, and reported that the most common adverse events encountered from days 1 to 14 included fatigue and injection-site pain. However, as a newly developed inactivated vaccine, its safety still needs to be verified in the general population through long-term follow-up and rare adverse events must be considered in clinical practice. The present study, for the first time, reported a woman who experienced ischemic colitis after administration of a second dose of the COVID-19 inactivated vaccine.

History of past illness

The patient’s diet history was normal and she did not experience adverse events after receiving the first dose of COVID-19 inactivated vaccine. A previous physical examination revealed that she had hyperlipidemia but she did not receive treatment and a normal bowel movement was noted.

Personal and family history

There is no personal and family history.

這樣一來，如蕓省心又省力，她開心到不行，在茶水間碰到他的時(shí)候，她攔住他，跟他說謝謝，完全忘了之前對(duì)他咬牙切齒的誓言。

Physical examination

In addition to confirming a normal menstrual cycle, physical examination revealed the following outcomes: Body mass index (BMI) of 21.1 kg/m

; body temperature of 36.2°C; heart rate of 80 beats/min; respiratory rate of 19 breaths/min; and blood pressure of 140/85 mmHg. Upon undergoing abdominal examination, her abdomen was soft with tenderness in the left lower quadrant and no rebound pain or muscle tension. Upon undergoing digital rectal examination, there were no masses and no blood was found in the finger sleeve.

Laboratory examinations

The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Imaging examinations

Computed tomography of the abdomen showed edema and bowel wall thickening with hypodensity in the sigmoid colon and descending colon (Figure 1). Colonoscopy revealed hyperemia, edema and erosion of the mucosa with superficial ulceration and a yellow-white coating located at the descending colon and sigmoid colon (Figure 2).

FlNAL DlAGNOSlS

This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BYNC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is noncommercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

TREATMENT

The symptoms of the disease were relieved after admission to our hospital and the disease was in complete remission after administration of pinaverium bromide (50 mg, tid) and aspirin enteric-coated tablets (0.1 g, qd) for 1 wk.

OUTCOME AND FOLLOW-UP

The patient did not present with abdominal pain or hematochezia and the frequency of defecation was once/day with soft yellow stool.

DlSCUSSlON

More than 24 million doses of the COVID-19 vaccines have been administered in China as of January 31,2021[10]. As the safety profile of vaccines could affect vaccination acceptance, resulting in the control of the COVID-19 pandemic, it is imperative to report all suspected adverse events. The incidence of anaphylaxis following the administration of the COVID-19 inactivated vaccines was recently reported at nearly 1.4 cases per one million doses[11]. The present study found that recipients of the second dose of COVID-19 inactivated vaccines experienced ischemic colitis, indicating the necessity of clinicians’ higher attention to vaccination in clinical practice.

The patient had received the second dose of the COVID-19 inactivated vaccine (4 ug/0.5 mL) in her deltoid muscle of the upper arm 1 d prior to her admission to our hospital and she did not experience any obvious discomfort during the injection. She experienced acute pain in the middle of her lower abdomen 1 h after the injection followed by 2 episodes of defecation characterized by small amounts of loose yellow stools. Subsequently, this was followed by more than 10 episodes of defecation characterized by small amounts of loose stools with hematochezia. These episodes were associated with fatigue. She did not present with nausea, vomiting, fever, dizziness or palpitations. The symptoms lasted for approximately 14 h before the appearance of abdominal pain and the hematochezia was gradually resolved spontaneously.

對(duì)此，考慮在現(xiàn)場居中位置的風(fēng)機(jī)盤管回風(fēng)管道上設(shè)置外置溫度傳感器，再連接到溫控面板上進(jìn)行解決，但目前溫度傳感器主要為熱敏電阻型，傳輸?shù)木嚯x要求控制在30m以內(nèi)，導(dǎo)致溫控面板位置在設(shè)置時(shí)會(huì)受到距離限制，無法統(tǒng)一設(shè)置在弱電間，而需要結(jié)合具體情況，考慮設(shè)置在就近的相關(guān)后勤機(jī)房及管井等酒店管理用房或天花板內(nèi)。

The onset time of ischemic colitis was closely correlated to the administration of the COVID-19 vaccines and a potential association could not be ruled out. Although the specific pathogenesis is elusive, the inflammation and immune reaction caused by vaccine administration could induce a hypercoagulable state. However, the levels of D-dimer and fibrinogen degradation product were normal which may be due to the acute onset of disease. Other inflammatory indices were normal as well. Increased intestinal peristalsis with sustained muscle contractions after vaccine administration could lead to the increase of intestinal pressure and vasospasm, in which the reduced blood volume due to frequent episodes of diarrhea could cause abdominal wall defects, mucosal ischemia, impaired metabolic function, acidosis, necrosis, gastric mucosal injury and bleeding[19].

Our patient received an inactivated vaccine which retained the immunogenicity of the virus without its pathogenic effect. Hence, although ischemic colitis can be induced by COVID-19, ischemic colitis in this patient might not be caused by SARS-CoV-2[20-22]. Studies have demonstrated that SARS-CoV-2 uses angiotensin-converting enzyme 2 (ACE2) receptor to facilitate viral entry into target cells. ACE-2 is expressed in pulmonary alveolar epithelial cells and throughout the gastrointestinal tract, including the colonic mucosa, thereby playing an important role in the development of ischemic colitis[23-25]. The present episode was transient with rapidly resolving symptoms indicating a relatively benign prognosis. Therefore, the inactivated vaccine should be applied against COVID-19 owing to the extremely low incidence of ischemic colitis.

CONCLUSlON

This report described the temporal relationship between the administration of the COVID-19 inactivated vaccine with ischemic colitis and discussed its possible causes. The potential mechanism behind the development of ischemic colitis in the present case remained obscure and further evaluation is required to understand and manage unforeseen complications of COVID-19 inactivated vaccines. Patients with abdominal pain accompanied by hematochezia at 1 d after administration of COVID-19 inactivated vaccines should be cautiously managed in clinical practice.

FOOTNOTES

Cui MH conceived and designed the case report, analyzed the data and wrote the manuscript;Hou ΧL participated in discussion and analysis of the case; Liu JY performed the literature review; All the authors read and approved the final version of this manuscript.

Written informed consent was obtained from the patient for publication of this case report and accompanying images.

The authors declare that they have no conflict of interest.

The results of hematological tests showed a normal C-reactive protein level, and the results of routine blood examination were as follows: D-dimer 329 ug/L; fibrinogen degradation product 2.5 mg/L;glucose 7.35 mmol/L; and lactic acid 2.60 mmol/L. The testing of nucleic acids, IgM and IgG showed negative results.

阿坤，我輸了。我還是輸了。我終于輸給了林強(qiáng)信那條老狗！這幾年，我使出渾身解數(shù)，想盡一切辦法，全力打拼，在商場上連滾帶爬，就是想證明給林強(qiáng)信看，我不會(huì)輸給他！他時(shí)時(shí)刻刻都想整死我，整死景花廠，現(xiàn)在，他終于如愿以償了。

Based on the above-mentioned results, the patient was diagnosed with ischemic colitis.

在傳統(tǒng)教學(xué)模式中，大多數(shù)教師對(duì)學(xué)生進(jìn)行填鴨式教育。這種教學(xué)方法只注重學(xué)生的學(xué)習(xí)成績以及他們的升學(xué)率，絲毫不注重學(xué)生對(duì)所學(xué)知識(shí)內(nèi)容的掌握程度。教師只是一味地給學(xué)生灌輸知識(shí)，學(xué)生也像機(jī)器一樣被動(dòng)接受知識(shí)。這就極大地限制了學(xué)生的自主學(xué)習(xí)能力以及他們的創(chuàng)新能力。國家對(duì)學(xué)生的要求不再是考試拿到好成績，更要注重學(xué)生學(xué)習(xí)的全面發(fā)展，尤其是他們的自主創(chuàng)新能力。這種能力將會(huì)伴隨學(xué)生一生的發(fā)展，在學(xué)習(xí)文化知識(shí)時(shí)，找到學(xué)習(xí)樂趣，并注重發(fā)揮自己的特長，在興趣的帶動(dòng)下激發(fā)自身的創(chuàng)造能力。

China

2018年以來更是動(dòng)作頻頻，夢妝入駐美國最大美妝零售商ULTA，悅詩風(fēng)吟成功進(jìn)軍日本，彩妝品牌赫妍與專業(yè)美發(fā)品牌AMOS PROFESSIONAL也成功登陸新加坡，蘭芝正式進(jìn)駐澳大利亞所有絲芙蘭門店，而伊蒂之屋在進(jìn)駐迪拜后，預(yù)計(jì)將進(jìn)駐中東最大美妝市場——沙特阿拉伯。

Mei-Hua Cui 0000-0001-8707-3031; Χiao-Lin Hou 0000-0002-6729-7481; Jun-Yuan Liu 0000-0002-3594-0444.

230 ℃高油溫，加入蒜茸、姜茸以及蔥茸炒制出香，炒制約5～8 min，鍋內(nèi)無明顯水蒸氣冒出即可。注意火力不能太大，鍋內(nèi)溫度控制在100～110 ℃；

Wu YΧJ

Filipodia

Wu YΧJ

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