Frontiers in Medicine (Jun 2021)

Pneumatosis Intestinalis in the Setting of COVID-19: A Single Center Case Series From New York

  • Santiago J. Miyara,
  • Santiago J. Miyara,
  • Lance B. Becker,
  • Lance B. Becker,
  • Lance B. Becker,
  • Lance B. Becker,
  • Lance B. Becker,
  • Sara Guevara,
  • Sara Guevara,
  • Claudia Kirsch,
  • Christine N. Metz,
  • Christine N. Metz,
  • Muhammad Shoaib,
  • Muhammad Shoaib,
  • Muhammad Shoaib,
  • Elliot Grodstein,
  • Vinay V. Nair,
  • Nicholas Jandovitz,
  • Nicholas Jandovitz,
  • Alexia McCann-Molmenti,
  • Kei Hayashida,
  • Kei Hayashida,
  • Ryosuke Takegawa,
  • Ryosuke Takegawa,
  • Koichiro Shinozaki,
  • Koichiro Shinozaki,
  • Tsukasa Yagi,
  • Tsukasa Yagi,
  • Tomoaki Aoki,
  • Tomoaki Aoki,
  • Mitsuaki Nishikimi,
  • Mitsuaki Nishikimi,
  • Rishabh C. Choudhary,
  • Rishabh C. Choudhary,
  • Young Min Cho,
  • Stavros Zanos,
  • Stavros Zanos,
  • Stefanos Zafeiropoulos,
  • Stefanos Zafeiropoulos,
  • Hannah B. Hoffman,
  • Stacey Watt,
  • Claudio M. Lumermann,
  • Claudio M. Lumermann,
  • Judith Aronsohn,
  • Judith Aronsohn,
  • Linda Shore-Lesserson,
  • Linda Shore-Lesserson,
  • Ernesto P. Molmenti,
  • Ernesto P. Molmenti,
  • Ernesto P. Molmenti

DOI
https://doi.org/10.3389/fmed.2021.638075
Journal volume & issue
Vol. 8

Abstract

Read online

This case series reviews four critically ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [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.

Keywords