Bowel ulceration following tocilizumab administration in a COVID-19 patient

Abstract

Tocilizumab, a monoclonal antibody against interleukin-6, has been used to treat cytokine release syndrome (CRS) in a subset of patients with severe COVID-19 disease. Acute ulcerative bowel disease has been only rarely documented in patients treated for rheumatological conditions. The gastrointestinal side effects seen when used in the context of COVID-19 are unknown. We present a case of COVID-19 CRS in which acute terminal ileum and perforated caecal ulceration evolved after tocilizumab exposure. We raise awareness of a possible causal relationship between even a single dose of tocilizumab and gut ulceration in patients with COVID-19. Any such drug enteropathy relationship requires watchful monitoring during upcoming trials of tocilizumab in patients with COVID-19.

Colonic perforation in 91- year- old man with severe Covid-19 infection

“…They assumed that the possible relationship between even a single dose of tocilizumab and gut ulceration in Covid-19 populations needs further investigation. [9]. In our case, the patient did not receive interleukin -6 receptor antagonist therapy.…”

“…The intestinal complication involving both small and large intestine was also recognized in a patient with Covid-19 infection who received treatment with tocilizumab. He was 43 year and he had ulceration in ileum with colitis and ileal perforation [9]. They assumed that the possible relationship between even a single dose of tocilizumab and gut ulceration in Covid-19 populations needs further investigation.…”

A Rare Case of Rheumatoid Arthritis with Tocilizumab-induced Intestinal Mucosal Injury

“…Few cases of TCZ-induced intestinal mucosal injury have been reported to date. (12,13) The characteristics of the lesions are unknown, and the diagnostic criteria for TCZinduced intestinal mucosal injury have not been reported. Therefore, its diagnosis is made by the exclusion of other potential diseases.…”

Thymoquinone: A Promising Natural Compound with Potential Benefits for COVID-19 Prevention and Cure

“… 169 TQ could also potentially counteract the toxic effects of various repurposed drugs, 170 , 171 such as the cardiotoxicity risk associated with chloroquine and azithromycin 161 , 172 , 173 and the potential liver and kidney toxicities associated with antivirals such as remdesivir and lopinavir. 155 , 161 , 170 TQ can also exert gastroprotective effects 160 against gastric ulceration, which is associated with the IL-6 antagonist, tocilizumab, 174 in addition to potentiating its anti-inflammatory effect. 175 …”