Chaudhry Bilal, Alekseyev Kirill, Didenko Lidiya, Chaudhry Maaria
Christiana Care Health System, Newark, DE, USA.
Post-Acute Medical Rehabilitation Hospital of Dover, Dover, DE, USA.
Clin Med Insights Case Rep. 2023 Jun 16;16:11795476231173870. doi: 10.1177/11795476231173870. eCollection 2023.
Coronavirus Disease 2019 (COVID-19) was first identified in Wuhan province in China in late 2019. Around 15% of patients that develop severe acute respiratory syndrome from COVID-19 also develop severe COVID-19 pneumonia. Since the pandemic's start, various treatments including remdesivir, dexamethasone, baricitinib, convalescent plasma, and tocilizumab have been approved by the Center for Disease Control (CDC). We present a case of a 62-year-old male hospitalized due to COVID-19 pneumonia and was initially treated with methylprednisolone and remdesivir, and later with tocilizumab. Soon after, he developed an abdominal perforation which was surgically treated. In terms of abdominal perforation, proposed mechanisms including the pathogenesis due to the presence of specific angiotensin-converting enzyme 2 (ACE-2) receptors located throughout the gastrointestinal tract, glucocorticoid steroid inflammatory suppression, in addition to the documented adverse effects from tocilizumab which has been previously reported. In summary, tocilizumab may increase the risk of abdominal perforation, especially when used in combination with steroids to treat COVID-19 because steroids may suppress clinical exam findings for abdominal perforation.
2019年冠状病毒病（COVID-19）于2019年末在中国湖北省首次被发现。感染COVID-19并发展为严重急性呼吸综合征的患者中，约15%还会发展为重症COVID-19肺炎。自疫情开始以来，包括瑞德西韦、地塞米松、巴瑞替尼、康复期血浆和托珠单抗在内的多种治疗方法已获美国疾病控制中心（CDC）批准。我们报告一例62岁男性因COVID-19肺炎住院，最初接受甲泼尼龙和瑞德西韦治疗，后来接受托珠单抗治疗。不久后，他发生了腹部穿孔并接受了手术治疗。关于腹部穿孔，提出的机制包括由于胃肠道中存在特定的血管紧张素转换酶2（ACE-2）受体导致的发病机制、糖皮质激素的炎症抑制作用，以及先前已报道的托珠单抗的不良反应。总之，托珠单抗可能会增加腹部穿孔的风险，尤其是在与类固醇联合用于治疗COVID-19时，因为类固醇可能会掩盖腹部穿孔的临床检查结果。
