Author: Schwab, Kristin; Hamidi, Sepehr; Chung, Augustine; Lim, Raymond J; Khanlou, Negar; Hoesterey, Daniel; Dumitras, Camelia; Adeyiga, Oladunni B; Phan-Tang, Michelle; Wang, Tisha S; Saggar, Rajan; Goldstein, Jeffrey; Belperio, John A; Dubinett, Steven M; Kim, Jocelyn T; Salehi-Rad, Ramin
Title: Occult colonic perforation in a patient with COVID-19 following interleukin-6 receptor antagonist therapy Cord-id: wz61p3vn Document date: 2020_9_12
ID: wz61p3vn
Snippet: Interleukin-6 blockade (IL-6) has become a focus of therapeutic investigation for the coronavirus-2019 (COVID-19). We report a case of a 34 year-old with COVID-19 pneumonia receiving an IL-6 receptor antagonist (IL-6Ra) who developed spontaneous colonic perforation. This perforation occurred despite a benign abdominal exam and in the absence of other known risk factors associated with colonic perforation. Examination of the colon by electron microscopy revealed numerous intact SARS-CoV-2 virions
Document: Interleukin-6 blockade (IL-6) has become a focus of therapeutic investigation for the coronavirus-2019 (COVID-19). We report a case of a 34 year-old with COVID-19 pneumonia receiving an IL-6 receptor antagonist (IL-6Ra) who developed spontaneous colonic perforation. This perforation occurred despite a benign abdominal exam and in the absence of other known risk factors associated with colonic perforation. Examination of the colon by electron microscopy revealed numerous intact SARS-CoV-2 virions abutting the microvilli of the colonic mucosa. Multiplex immunofluorescent staining revealed the presence of the SARS-CoV-2 spike protein on the brush borders of colonic enterocytes which expressed angiotensin-converting enzyme 2. However, no viral particles were observed within the enterocytes to suggest direct viral injury as the cause of colonic perforation. These data and absence of known risk factors for spontaneous colonic perforation implicate IL-6Ra therapy as the potential mediator of colonic injury in this case. Furthermore, this report provides the first in situ visual evidence of the virus in the colon of a patient presenting with colonic perforation adding to growing evidence that intact infectious virus can be present in the stool.
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