Perforación intestinal en paciente COVID-19 en tratamiento con tocilizumab y corticoides. A propósito de un caso

Guardiola, Paula Gonzálvez; Ares, José Ángel Díez; Tomás, Nuria Peris; Tomás, Juan Carlos Sebastián; Martínez, Sergio Navarro

doi:10.1016/j.ciresp.2020.04.030

Cited by 15 publications

(12 citation statements)

References 10 publications

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“…[ 12 – 14 ] COVID-19 have been rarely reported to result in GI perforation. Till the date of writing this report only 13 cases [ 15 – 23 ] have been reported in the literature (Table 2 ). In addition, Meini et al reported a case of pneumatosis intestinalis in association with COVID-19 but without perforation.…”

Section: Discussionmentioning

confidence: 99%

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Gastrointestinal perforation secondary to COVID-19

Argan¹,

Alqatari²,

Said³

et al. 2021

Medicine

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Introduction: Corona virus disease-2019 (COVID-19) presents primarily with respiratory symptoms. However, extra respiratory manifestations are being frequently recognized including gastrointestinal involvement. The most common gastrointestinal symptoms are nausea, vomiting, diarrhoea and abdominal pain. Gastrointestinal perforation in association with COVID-19 is rarely reported in the literature. Patient concerns and diagnosis: In this series, we are reporting 3 cases with different presentations of gastrointestinal perforation in the setting of COVID-19. Two patients were admitted with critical COVID-19 pneumonia, both required intensive care, intubation and mechanical ventilation. The first one was an elderly gentleman who had difficult weaning from mechanical ventilation and required tracheostomy. During his stay in intensive care unit, he developed Candidemia without clear source. After transfer to the ward, he developed lower gastrointestinal bleeding and found by imaging to have sealed perforated cecal mass with radiological signs of peritonitis. The second one was an obese young gentleman who was found incidentally to have air under diaphragm. Computed tomography showed severe pneumoperitoneum with cecal and gastric wall perforation. The third case was an elderly gentleman who presented with severe COVID-19 pneumonia along with symptoms and signs of acute abdomen who was confirmed by imaging to have sigmoid diverticulitis with perforation and abscess collection. Interventions: The first 2 cases were treated conservatively. The third one was treated surgically. Outcome: Our cases had a variable hospital course but fortunately all were discharged in a good clinical condition. Conclusion: Our aim from this series is to highlight this fatal complication to clinicians in order to enrich our understanding of this pandemic and as a result improve patients’ outcome.

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Section: Discussionmentioning

confidence: 99%

“…Other indications were signs of peritonitis, [ 16 ] worsening hemodynamics [ 17 , 18 , 21 ] and rising inflammatory markers. [ 15 ]…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal perforation secondary to COVID-19

Argan¹,

Alqatari²,

Said³

et al. 2021

Medicine

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“…ACE2 found abundantly in type 2 pneumocytes in the lung, intestinal mucosa and to lesser extent in the liver and biliary tree. [12] SARS-CoV-2 shows more than 80% structural similarity to SARS-CoV. Recent studies demonstrated the presence of SARS-CoV-2 viral nucleocapsid protein in the gastrointestinal tract.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Associated Spontaneous Bowel Perforation

Alkatary¹,

Zarooni²,

Harthi³

2021

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The purpose of this article is to report on the newly recognized life threating gastrointestinal complications of Corona virus infection in the form of bowel ischemia and ischemic bowel perforation. In a retrospective observational study at Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, United Arab Emirates during the period between March and May 2020. All COVID-19 positive patients with free intra peritoneal air were included; total of five patients met our inclusion criteria during the study period, all patients were admitted to the intensive care unit for mechanical ventilation and management of severe COVID 19 related respiratory complications. COVID-19 status was based on a positive PCR nasopharyngeal swab supported by typical radiological findings on either chest X-ray (CXR) or CT Chest. Free air under the diaphragm was radiologically confirmed in all patients. Patients' demographics and co-morbidities were reviewed. Four patients underwent an emergency surgical intervention confirming ischemic perforation of the right colon. The caecum was identified as the starting point of ischemia with variable distal extension into the ascending colon and the hepatic flexure. One patient unfortunately demised prior to surgery due to severe septic complications. These findings highlight the importance of paying attention to COVID 19 patients with sudden clinical deterioration and raise the extent of the gastrointestinal manifestation of COVID-19 infection beyond simple diarrhea and abdominal pain.

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“…Furthermore, the clinical response to tocilizumab seems to be negatively affected by hyperglycemia, shown to be associated with increased IL6 levels [168]. In regard to tocilizumab safety, concerns have been raised about the risk of candidemia, septic shock and possible occurrence of intestinal perforation (an adverse effects reported in rheumatoid arthritis patients), which may be favored by the altered hemodynamics observed in critically ill COVID-19 patients [163,[169][170][171]. Based on these initial data, the efficacy and safety of tocilizumab in severe COVID-19 need to be corroborated by the results of the ongoing randomized controlled clinical trials.…”

Section: Drugs Used To Counteract the Cytokine Stormmentioning

confidence: 99%

Approaching coronavirus disease 2019: Mechanisms of action of repurposed drugs with potential activity against SARS-CoV-2

Lisi¹,

Lacal

Barbaccia

et al. 2020

Biochemical Pharmacology

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On March 11, 2020, the World Health Organization (WHO) declared the severe acute respiratory syndrome caused by coronavirus 2 (SARS-CoV-2) a global pandemic. As of July 2020, SARS-CoV-2 has infected more than 14 million people and provoked more than 590,000 deaths, worldwide. From the beginning, a variety of pharmacological treatments has been empirically used to cope with the life-threatening complications associated with Corona Virus Disease 2019 (COVID-19). Thus far, only a couple of them and not consistently across reports have been shown to further decrease mortality, respect to what can be achieved with supportive care. In most cases, and due to the urgency imposed by the number and severity of the patients' clinical conditions, the choice of treatment has been limited to repurposed drugs, approved for other indications, or investigational agents used for other viral infections often rendered available on a compassionate-use basis. The rationale for drug selection was mainly, though not exclusively, based either i) on the activity against other coronaviruses or RNA viruses in order to potentially hamper viral entry and replication in the epithelial cells of the airways, and/or ii) on the ability to modulate the excessive inflammatory reaction deriving from dysregulated host immune responses against the SARS-CoV-2. In several months, an exceptionally large number of clinical trials have been designed to evaluate the safety and efficacy of anti-COVID-19 therapies in different clinical settings (treatment or pre-and post-exposure prophylaxis) and levels of disease severity, but only few of them have been completed so far. This review focuses on the molecular mechanisms of action that have provided the scientific rationale for the empirical use and evaluation in clinical trials of structurally different and often functionally unrelated drugs during the SARS-CoV-2 pandemic.

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Perforación intestinal en paciente COVID-19 en tratamiento con tocilizumab y corticoides. A propósito de un caso

Cited by 15 publications

References 10 publications

Gastrointestinal perforation secondary to COVID-19

Gastrointestinal perforation secondary to COVID-19

COVID-19 Associated Spontaneous Bowel Perforation

Approaching coronavirus disease 2019: Mechanisms of action of repurposed drugs with potential activity against SARS-CoV-2

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