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

coronavirus electron microscopy interleukin-6 receptors intestinal perforation

Journal

Open forum infectious diseases
ISSN: 2328-8957
Titre abrégé: Open Forum Infect Dis
Pays: United States
ID NLM: 101637045

Informations de publication

Date de publication:
Nov 2020
Historique:
received: 18 06 2020
accepted: 09 09 2020
entrez: 18 11 2020
pubmed: 19 11 2020
medline: 19 11 2020
Statut: epublish

Résumé

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

Sections du résumé

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

Identifiants

DOI: 10.1093/ofid/ofaa424 PMID: 33204749 PMC: PMC7543619
pubmed: 33204749
doi: 10.1093/ofid/ofaa424
pii: ofaa424
pmc: PMC7543619
doi:

Types de publication

Journal Article

Langues

eng

Pagination

ofaa424

Subventions

Organisme : NIAID NIH HHS
ID : K08 AI155232
Pays : United States
Organisme : NCATS NIH HHS
ID : KL2 TR001882
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001881
Pays : United States

Informations de copyright

© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

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Auteurs

Kristin Schwab (K)

Division of Pulmonary and Critical Care, Department of Medicine at University of California, Los Angeles, California, USA.
ORCID: 0000-0003-0288-7568

Sepehr Hamidi (S)

Department of Pathology and Laboratory Medicine at University of California, Los Angeles, California, USA.

Augustine Chung (A)

Division of Pulmonary and Critical Care, Department of Medicine at University of California, Los Angeles, California, USA.

Raymond J Lim (RJ)

Department of Molecular and Medical Pharmacology at University of California, Los Angeles, California, USA.

Negar Khanlou (N)

Department of Pathology and Laboratory Medicine at University of California, Los Angeles, California, USA.

Daniel Hoesterey (D)

Department of Medicine at University of California, Los Angeles, California, USA.

Camelia Dumitras (C)

Division of Pulmonary and Critical Care, Department of Medicine at University of California, Los Angeles, California, USA.

Oladunni B Adeyiga (OB)

Division of Infectious Diseases, Department of Medicine at University of California, Los Angeles, California, USA.

Michelle Phan-Tang (M)

Department of Pathology and Laboratory Medicine at University of California, Los Angeles, California, USA.

Tisha S Wang (TS)

Division of Pulmonary and Critical Care, Department of Medicine at University of California, Los Angeles, California, USA.

Rajan Saggar (R)

Division of Pulmonary and Critical Care, Department of Medicine at University of California, Los Angeles, California, USA.

Jeffrey Goldstein (J)

Department of Pathology and Laboratory Medicine at University of California, Los Angeles, California, USA.

John A Belperio (JA)

Division of Pulmonary and Critical Care, Department of Medicine at University of California, Los Angeles, California, USA.

Steven M Dubinett (SM)

Division of Pulmonary and Critical Care, Department of Medicine at University of California, Los Angeles, California, USA.
Department of Pathology and Laboratory Medicine at University of California, Los Angeles, California, USA.
Department of Molecular and Medical Pharmacology at University of California, Los Angeles, California, USA.
Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
Jonsson Comprehensive Cancer Center at University of California, Los Angeles, California, USA.

Jocelyn T Kim (JT)

Division of Infectious Diseases, Department of Medicine at University of California, Los Angeles, California, USA.

Ramin Salehi-Rad (R)

Division of Pulmonary and Critical Care, Department of Medicine at University of California, Los Angeles, California, USA.
Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.

Classifications MeSH