Pneumatosis intestinalis in the setting of COVID-19: a single center case series from New York

Abstract

This case series reviews four critically ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [coronavirus disease 2019 (COVID-19)] suffering from pneumatosis intestinalis (PI) during their hospital admission. All patients received the biological agent tocilizumab (TCZ), an interleukin (IL)-6 antagonist, as an experimental treatment for COVID-19 before developing PI. COVID-19 and TCZ have been independently linked to PI risk, yet the cause of this relationship is unknown and under speculation. PI is a rare condition, defined as the presence of gas in the intestinal wall, and although its pathogenesis is poorly understood, intestinal ischemia is one of its causative agents. Based on COVID-19's association with vasculopathic and ischemic insults, and IL-6's protective role in intestinal epithelial ischemia–reperfusion injury, an adverse synergistic association of COVID-19 and TCZ can be proposed in the setting of PI. To our knowledge, this is the first published, single center, case series of pneumatosis intestinalis in COVID-19 patients who received tocilizumab therapy.

Metadata

Item Type:	Article
Authors/Creators:	Miyara, S.J. Becker, L.B. Guevara, S. Kirsch, C. https://orcid.org/0000-0002-4978-4198 Metz, C.N. Shoaib, M. Grodstein, E. Nair, V.V. Jandovitz, N. McCann-Molmenti, A. Hayashida, K. Takegawa, R. Shinozaki, K. Yagi, T. Aoki, T. Nishikimi, M. Choudhary, R.C. Cho, Y.M. Zanos, S. Zafeiropoulos, S. Hoffman, H.B. Watt, S. Lumermann, C.M. Aronsohn, J. Shore-Lesserson, L. Molmenti, E.P.
Copyright, Publisher and Additional Information:	© 2021 Miyara, Becker, Guevara, Kirsch, Metz, Shoaib, Grodstein, Nair, Jandovitz, McCann-Molmenti, Hayashida, Takegawa, Shinozaki, Yagi, Aoki, Nishikimi, Choudhary, Cho, Zanos, Zafeiropoulos, Hoffman, Watt, Lumermann, Aronsohn, Shore-Lesserson and Molmenti. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Keywords:	pneumatosis intestinalis; COVID-19; SARS-CoV-2; mesenteric ischemia; ischemia-reperfusion injury; molecular targeted therapy; tocilizumab; IL-6 inhibitor
Dates:	Published: 4 June 2021 Published (online): 4 June 2021 Accepted: 8 March 2021
Institution:	The University of Sheffield
Academic Units:	The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Clinical Dentistry (Sheffield)
Depositing User:	Symplectic Sheffield
Date Deposited:	16 Sep 2022 10:38
Last Modified:	16 Sep 2022 10:45
Status:	Published
Publisher:	Frontiers Media S.A.
Refereed:	Yes
Identification Number:	10.3389/fmed.2021.638075
Related URLs:	Author
Open Archives Initiative ID (OAI ID):	oai:eprints.whiterose.ac.uk:190635

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Pneumatosis intestinalis in the setting of COVID-19: a single center case series from New York

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