Multiple drugsVarious toxicities: case report A 37-year-old man developed acute kidney injury (AKI) while receiving remdesivir for COVID-19 pneumonia. Additionally, he developed gastrointestinal haemorrhage, colon perforation and colonic ulcer while receiving sodium polystyrene sulfonate for hyperkalemia, zirconium-silicate for hyperkalemia and sevelamer for elevated phosphorus. He also experienced lack of efficacy during treatment with remdesivir for COVID-19 pneumonia [dosages, routes, durations of treatments to reactions onsets and outcomes not stated].The man, who had asthma and hypertension, presented to an outside hospital with respiratory distress and presumed asthma exacerbation. He was initially placed on high flow nasal cannula and unspecified steroids. A subsequent testing for SARS-CoV-2 was found to be positive. He was subsequently intubated and placed on mechanical ventilation due to worsening respiratory status. Imaging reportedly showed patchy diffuse bilateral consolidative and ground-glass infiltrates, conferring lack of efficacy during treatment with remdesivir. His WBC count was elevated, and he was placed on unspecified broad spectrum antibiotics. His outside hospital course was complicated by AKI with increased creatinine and hyperkalaemia for which he was given sodium polystyrene sulfonate [Kayexalate]. After approximately 10 days of admission and worsening condition, he was transferred to another hospital. On admission, remdesivir was held due to renal failure, and antibiotics were discontinued as he had received an appropriate duration at the outside hospital. He was started on heparin due to the hypercoagulable state (elevated D-dimer). He was transferred to the medical ICU for acute hypoxic respiratory failure in the setting of COVID-19 pneumonia complicated by AKI. Lab results were notable for continued hyperkalaemia and elevated phosphorus for which he was treated with zirconium-silicate [Lokelma] and sevelamer [Renvela], respectively. Liver enzymes (AST and ALT) were also elevated. After nearly 2 weeks of admission at another hospital, his haemoglobin began to drop and there was clinical concern for a gastrointestinal bleed. At that time, he did not have any abdominal pain but experienced one episode of non-bloody emesis for which a nasogastric tube was placed. Subsequently, he developed a distended abdomen and reported an episode of haematochezia, which prompted an abdominal X-ray that showed multiple dilated loops of small bowel with concern for pneumoperitoneum. Thereafter, a CT scan of the abdomen confirmed the pneumoperitoneum, and he was taken for exploratory laparotomy. Intraoperatively, bloody fluid was noted in the pelvis and a firm mass was palpated along the mid ascending colon, which was highly suggestive of colon cancer.A right hemicolectomy was performed. The gross findings were significant for a single perforated ulcer in the ascending colon with multiple additional smaller ulcers ranging from 0.3 to 1.3cm. Microscopic examination revealed a transmural ulcer associated ...
