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Bowel ulceration following tocilizumab administration in a COVID-19 patient

Damian Bruce-Hickman1, Shanaz Matthew Sajeed2, Yin Huei Pang3

  • 1Intensive Care Medicine, Ng Teng Fong General Hospital, National University Health System, Singapore damian_andrew_david_bruce-hickman@nuhs.edu.sg.

BMJ Open Gastroenterology
|August 21, 2020
PubMed

Tocilizumab, a monoclonal antibody against interleukin-6, has been used to treat cytokine release syndrome (CRS) in a subset of patients with severe COVID-19 disease. Acute ulcerative bowel disease has been only rarely documented in patients treated for rheumatological conditions. The gastrointestinal side effects seen when used in the context of COVID-19 are unknown. We present a case of COVID-19 CRS in which acute terminal ileum and perforated caecal ulceration evolved after tocilizumab exposure. We raise awareness of a possible causal relationship between even a single dose of tocilizumab and gut ulceration in patients with COVID-19. Any such drug enteropathy relationship requires watchful monitoring during upcoming trials of tocilizumab in patients with COVID-19.

Keywords:
abdominal surgeryadverse drug reactionscolonoscopydrug toxicity

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