Miyara Santiago J, Becker Lance B, Guevara Sara, Kirsch Claudia, Metz Christine N, Shoaib Muhammad, Grodstein Elliot, Nair Vinay V, Jandovitz Nicholas, McCann-Molmenti Alexia, Hayashida Kei, Takegawa Ryosuke, Shinozaki Koichiro, Yagi Tsukasa, Aoki Tomoaki, Nishikimi Mitsuaki, Choudhary Rishabh C, Cho Young Min, Zanos Stavros, Zafeiropoulos Stefanos, Hoffman Hannah B, Watt Stacey, Lumermann Claudio M, Aronsohn Judith, Shore-Lesserson Linda, Molmenti Ernesto P
Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, United States.
Feinstein Institutes for Medical Research, Manhasset, NY, United States.
Front Med (Lausanne). 2021 Jun 4;8:638075. doi: 10.3389/fmed.2021.638075. eCollection 2021.
This case series reviews four critically ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARSCoV2) [coronavirus disease 2019 (COVID-19)] suffering from pneumatosis intestinalis (PI) during their hospital admission. All patients received the biological agent tocilizumab (TCZ), an interleukin (IL)-6 antagonist, as an experimental treatment for COVID-19 before developing PI. COVID-19 and TCZ have been independently linked to PI risk, yet the cause of this relationship is unknown and under speculation. PI is a rare condition, defined as the presence of gas in the intestinal wall, and although its pathogenesis is poorly understood, intestinal ischemia is one of its causative agents. Based on COVID-19's association with vasculopathic and ischemic insults, and IL-6's protective role in intestinal epithelial ischemia-reperfusion injury, an adverse synergistic association of COVID-19 and TCZ can be proposed in the setting of PI. To our knowledge, this is the first published, single center, case series of pneumatosis intestinalis in COVID-19 patients who received tocilizumab therapy.
本病例系列回顾了4例感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）[冠状病毒病2019（COVID-19）]的危重症患者，他们在住院期间发生了肠壁积气（PI）。所有患者在发生PI之前均接受了生物制剂托珠单抗（TCZ），一种白细胞介素（IL）-6拮抗剂，作为COVID-19的实验性治疗。COVID-19和TCZ均与PI风险独立相关，但其关联原因尚不清楚且存在推测。PI是一种罕见疾病，定义为肠壁内存在气体，尽管其发病机制了解甚少，但肠道缺血是其病因之一。基于COVID-19与血管病变和缺血性损伤的关联，以及IL-6在肠上皮缺血-再灌注损伤中的保护作用，可提出在PI背景下COVID-19与TCZ存在不良协同关联。据我们所知，这是首个发表的、单中心、关于接受托珠单抗治疗的COVID-19患者发生肠壁积气的病例系列。
