Occult Colonic Perforation in a Patient With Coronavirus Disease 2019 After Interleukin-6 Receptor Antagonist Therapy.

Abstract

BACKGROUND:

Interleukin-6 blockade (IL-6) has become a focus of therapeutic investigation for the coronavirus disease 2019 (COVID-19).

METHODS:

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.

RESULTS:

Examination of the colon by electron microscopy revealed numerous intact severe acute respiratory syndrome coronavirus 2 (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 that 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.

CONCLUSIONS:

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.

• Authors: Kristin Schwab, Sepehr Hamidi, Augustine Chung, Raymond J Lim, Negar Khanlou, Daniel Hoesterey, Camelia Dumitras, Oladunni B Adeyiga, Michelle Phan-Tang, Tisha S Wang, Rajan Saggar, Jeffrey Goldstein, John A Belperio, Steven M Dubinett, Jocelyn T Kim, Ramin Salehi-Rad
• Journal: Open forum infectious diseases (Open Forum Infect Dis) Vol. 7 Issue 11 Pg. ofaa424 (Nov 2020) ISSN: 2328-8957 [Print] United States
• PMID: 33204749 (Publication Type: Journal Article)
• Copyright: © The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.