Acute colonic pseudo-obstruction syndrome in patients with severe COVID-19 in Buenos Aires, Argentina

Gulisano, Luciana María; Ianiro Swiderski, Joaquín José; Fernández, Marisa Liliana; Giuliano, Juan Franco; Fernández Stepa, Ana Laura; Dominguez, Cecilia; Nahoum, Nicolás; Jourdan, Johana; Trombetta, Luis Ángel; García, Julián Luis

doi:10.1016/j.tmaid.2023.102604

Cited by 1 publication

(1 citation statement)

References 34 publications

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“…However, the SLE disease activity index of our case scored 2, while the SLE disease activity score was 1.12, both indicating remission of the disease. Paralytic ileus was also recognized as an extrapulmonary manifestation of patients with severe COVID-19 (Ibrahim et al, 2020;Gulisano et al, 2023;Moghimi et al, 2023), which was not consistent with this case. Based on the above, the paralytic ileus was most likely result from the DDI between tacrolimus and nirmatrelvir/ritonavir in this report, supported by the toxicokinetic data.…”

Section: Discussioncontrasting

confidence: 71%

Case report: Paralytic ileus resulted from nirmatrelvir/ritonavir-tacrolimus drug-drug interaction in a systemic lupus erythematosus patient with COVID-19

Zhang,

Han

et al. 2024

Front. Pharmacol.

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Patients with systemic autoimmune rheumatic diseases are at a high risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and effective antiviral treatments including nirmatrelvir/ritonavir can improve their outcomes. However, there might be potential drug-drug interactions when these patients take nirmatrelvir/ritonavir together with immunosuppressants with a narrow therapeutic window, such as tacrolimus and cyclosporine. We present a case of paralytic ileus resulting from tacrolimus toxicity mediated by the use of nirmatrelvir/ritonavir in a patient with systemic lupus erythematosus (SLE). A 37-year-old female SLE patient was prescribed nirmatrelvir/ritonavir without discontinuing tacrolimus. She presented to the emergency room with symptoms of paralytic ileus including persistent abdominal pain, nausea, and vomiting, which were verified to be associated with tacrolimus toxicity. The blood concentration of tacrolimus was measured >30 ng/mL. Urgent medical intervention was initiated, while tacrolimus was withheld. The residual concentration was brought within the appropriate range and tacrolimus was resumed 8 days later. Physicians must be aware of the potential DDIs when prescribing nirmatrelvir/ritonavir, especially to those taking immunosuppresants like tacrolimus.

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Section: Discussioncontrasting

confidence: 71%