Pneumatosis Intestinalis in the Setting of COVID-19: A Single Center Case Series From New York

Frontiers in Medicine

Vinay V. Nair¹  Claudia Kirsch²  Alexia McCann-Molmenti³  Hannah B. Hoffman³  Elliot Grodstein³  Young Min Cho³  Sara Guevara⁴  Ernesto P. Molmenti⁵  Nicholas Jandovitz⁶  Claudio M. Lumermann⁷  Judith Aronsohn⁷  Linda Shore-Lesserson⁷  Stefanos Zafeiropoulos⁸  Christine N. Metz⁸  Stavros Zanos⁸  Santiago J. Miyara⁸  Lance B. Becker⁹  Ryosuke Takegawa^1,10  Tomoaki Aoki^1,10  Kei Hayashida^1,10  Koichiro Shinozaki^1,10  Rishabh C. Choudhary^1,10  Tsukasa Yagi^1,10  Mitsuaki Nishikimi^1,10  Muhammad Shoaib^1,11  Stacey Watt^1,12 

[1] Department of Medicine, North Shore University Hospital, Manhasset, NY, United States;Department of Radiology, North Shore University Hospital, Manhasset, NY, United States;Department of Surgery, North Shore University Hospital, Manhasset, NY, United States;Department of Surgery, North Shore University Hospital, Manhasset, NY, United States;Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States;Department of Surgery, North Shore University Hospital, Manhasset, NY, United States;Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States;Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States;Department of Surgery, North Shore University Hospital, Manhasset, NY, United States;Department of Pharmacy, North Shore University Hospital, Manhasset, NY, United States;Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States;Department of Anesthesiology, North Shore University Hospital, Manhasset, NY, United States;Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, United States;Feinstein Institutes for Medical Research, Manhasset, NY, United States;Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, United States;Feinstein Institutes for Medical Research, Manhasset, NY, United States;Department of Surgery, North Shore University Hospital, Manhasset, NY, United States;Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States;Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States;Feinstein Institutes for Medical Research, Manhasset, NY, United States;Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States;Feinstein Institutes for Medical Research, Manhasset, NY, United States;Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States;Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States;Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States;

关键词: pneumatosis intestinalis;    COVID-19;    SARS-CoV-2;    mesenteric ischemia;    ischemia-reperfusion injury;    molecular targeted therapy;    tocilizumab;    IL-6 inhibitor;   

DOI  :  10.3389/fmed.2021.638075

来源: Frontiers

【 摘 要 】

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.

【 授权许可】

CC BY