AUTHOR=Miyara Santiago J. , Becker Lance B. , Guevara Sara , Kirsch Claudia , Metz Christine N. , Shoaib Muhammad , Grodstein Elliot , Nair Vinay V. , Jandovitz Nicholas , McCann-Molmenti Alexia , Hayashida Kei , Takegawa Ryosuke , Shinozaki Koichiro , Yagi Tsukasa , Aoki Tomoaki , Nishikimi Mitsuaki , Choudhary Rishabh C. , Cho Young Min , Zanos Stavros , Zafeiropoulos Stefanos , Hoffman Hannah B. , Watt Stacey , Lumermann Claudio M. , Aronsohn Judith , Shore-Lesserson Linda , Molmenti Ernesto P. 

TITLE=Pneumatosis Intestinalis in the Setting of COVID-19: A Single Center Case Series From New York

JOURNAL=Frontiers in Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.638075

DOI=10.3389/fmed.2021.638075

ISSN=2296-858X

ABSTRACT=<p>This case series reviews four critically ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS<italic>-</italic>CoV<italic>-</italic>2) [coronavirus disease 2019 (COVID-19)] suffering from pneumatosis intestinalis (PI) during their hospital admission. All patients received the biological agent tocilizumab (TCZ), an interleukin (IL)-6 antagonist, as an experimental treatment for COVID-19 before developing PI. COVID-19 and TCZ have been independently linked to PI risk, yet the cause of this relationship is unknown and under speculation. PI is a rare condition, defined as the presence of gas in the intestinal wall, and although its pathogenesis is poorly understood, intestinal ischemia is one of its causative agents. Based on COVID-19's association with vasculopathic and ischemic insults, and IL-6's protective role in intestinal epithelial ischemia–reperfusion injury, an adverse synergistic association of COVID-19 and TCZ can be proposed in the setting of PI. To our knowledge, this is the first published, single center, case series of pneumatosis intestinalis in COVID-19 patients who received tocilizumab therapy.</p>