COVID 19 and the risk of gastro-intestinal perforation: A case series and literature review

Bulte, J.P.; Postma, Nynke; Beukema, Menno; Inberg, B.; Stegeman, Abe Gerrit; Hoeven, Hans van der

doi:10.1016/j.jcrc.2021.10.020

Cited by 18 publications

(17 citation statements)

References 34 publications

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“…At the time of the global COVID-19 pandemic, tocilizumab has been increasingly used to treat selected patients with critical COVID-19 infections since the publication of the RECOVERY trial [ 8 ]. A recent review has reported that GIPs can be an unusual complication of severe COVID-19 disease, as a total of 25 cases of COVID-associated GIPs were identified up to the time of that review writing in April 2021 [ 9 ], with seven of those cases being treated with tocilizumab [ 9 ], supporting pre-pandemic literature that documented this association. Understandably, the concomitant use of steroids compounds the GIP risks among the COVID-19 population [ 9 ].…”

Section: Discussionmentioning

confidence: 91%

“…A recent review has reported that GIPs can be an unusual complication of severe COVID-19 disease, as a total of 25 cases of COVID-associated GIPs were identified up to the time of that review writing in April 2021 [ 9 ], with seven of those cases being treated with tocilizumab [ 9 ], supporting pre-pandemic literature that documented this association. Understandably, the concomitant use of steroids compounds the GIP risks among the COVID-19 population [ 9 ]. It is worth mentioning that GIPs were associated with adverse morbidities in critical COVID-19 patients [ 9 ].…”

Section: Discussionmentioning

confidence: 91%

“…Understandably, the concomitant use of steroids compounds the GIP risks among the COVID-19 population [ 9 ]. It is worth mentioning that GIPs were associated with adverse morbidities in critical COVID-19 patients [ 9 ]. Therefore, physicians should be aware of this serious complication of tocilizumab therapy despite being a rare phenomenon, and early recognition with timely management of GIPs would minimize further potential morbidities.…”

Section: Discussionmentioning

confidence: 99%

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Tocilizumab-Associated Small Bowel Perforation in a Young Patient With Rheumatoid Arthritis: A Lesson to Remember During COVID-19 Pandemic

et al. 2022

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Tocilizumab is a recombinant humanized monoclonal antibody directed against the interleukin-6 (IL-6) receptor, which has been used for the treatment of rheumatoid arthritis (RA). A range of side effects have been associated with tocilizumab, with gastrointestinal perforation (GIP) being described as a rare but potentially life-threatening complication that deserves considerable attention. The authors report a case of a young male patient with a history of challenging RA who encountered a lower GIP that was associated with tocilizumab therapy. The occurrence of tocilizumab-induced GIP in this reported patient had initially posed a diagnostic dilemma, as its clinical presentation mimicked other autoimmune inflammatory and infectious diseases that are commonly associated with RA. Physicians should be aware of GIPs as a serious adverse event of tocilizumab use despite being a rare phenomenon, particularly in the era of the global pandemic of coronavirus disease 2019 (COVID-19), when this novel drug has been authorized for the management of selected patients with severe COVID-19 infection. Therefore, early recognition and timely management of GIPs would minimize potential morbidities associated with critically ill COVID-19 patients.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Tocilizumab-Associated Small Bowel Perforation in a Young Patient With Rheumatoid Arthritis: A Lesson to Remember During COVID-19 Pandemic

et al. 2022

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“…The virus may also induce ischemia secondary to massive endothelial dysfunction, widespread coagulopathy, and complement-induced thrombosis can lead to the development of systemic microangiopathy and thromboembolism [ 5 ]. While these factors can lead to the weakening of the gastrointestinal wall, it is also important to understand the role immunosuppressive or anti-inflammatory agents may have in an impairing inflammatory response [ 2 ], as they reduce systemic inflammation before it overwhelmingly results in multi-organ dysfunction [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…To continue the invention of novel methods we need to understand the complications that arise due to the disease and its treatments. Gastrointestinal perforation in association with COVID-19 has been reported 25 times to date [ 2 ]. We report a case of bowel perforation in a 72-year-old male patient with severe COVID-19 infection with no past history of gastrointestinal disease.…”

Section: Introductionmentioning

confidence: 99%

COVID-19 Infection Related Bowel Perforation

Alnabwani¹,

Ganta²,

Kochhar³

et al. 2022

Cureus

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During an ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel virus, new discoveries about its complications and treatment are made every day. Bowel perforation is another rarely reported complication due to the virus itself leading to ischemia or can be due to the treatment with antiviral drugs that reduces the integrity of epithelial barriers. This makes the bowel more prone to perforation even in patients with no prior history of bowel disease. We report a case of bowel perforation in a 72-year-old male patient with severe COVID-19 infection.

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