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

Kristin Schwab1, Sepehr Hamidi2, Augustine Chung1

  • 1Division of Pulmonary and Critical Care, Department of Medicine at University of California, Los Angeles, California, USA.

Open Forum Infectious Diseases
|November 18, 2020
PubMed
Abstract

Insights

Interleukin-6 receptor antagonist therapy for COVID-19 may be linked to spontaneous colonic perforation. This case highlights potential risks of IL-6 blockade and confirms SARS-CoV-2 presence in the colon.

Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Pharmacology

Background:

  • Interleukin-6 (IL-6) blockade is investigated for treating COVID-19.
  • Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can affect multiple organs.

Purpose of the Study:

  • To report a case of spontaneous colonic perforation in a COVID-19 patient treated with an IL-6 receptor antagonist (IL-6Ra).
  • To investigate the potential role of IL-6Ra therapy and SARS-CoV-2 in colonic injury.

Main Methods:

  • Case report of a 34-year-old patient with COVID-19 pneumonia.
  • Analysis of colonic tissue using electron microscopy and multiplex immunofluorescent staining.
  • Assessment for risk factors of colonic perforation.

Main Results:

  • The patient developed spontaneous colonic perforation despite a normal abdominal exam and no other known risk factors.
  • Electron microscopy showed intact SARS-CoV-2 virions on colonic mucosa.
  • SARS-CoV-2 spike protein was detected on enterocytes expressing ACE2, but no intracellular viral particles were observed.

Conclusions:

  • IL-6 receptor antagonist therapy is implicated as a potential cause of colonic injury in this case.
  • This study provides the first in situ evidence of SARS-CoV-2 in the colon of a patient with colonic perforation.
  • The findings suggest intact infectious virus may be present in stool, contributing to gastrointestinal complications.
Keywords:
coronaviruselectron microscopyinterleukin-6 receptorsintestinal perforation

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