Bowel ulceration following tocilizumab administration in a COVID-19 patient

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 gastrointestin...

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Main Authors: Damian Bruce-Hickman, Shanaz Matthew Sajeed, Yin Huei Pang, Choon Sheong Seow, Weihao Chen, Monika Gulati Kansal
Format: Article
Language:English
Published: BMJ Publishing Group 2020-12-01
Series:BMJ Open Gastroenterology
Online Access:https://bmjopengastro.bmj.com/content/7/1/e000484.full
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author Damian Bruce-Hickman
Shanaz Matthew Sajeed
Yin Huei Pang
Choon Sheong Seow
Weihao Chen
Monika Gulati Kansal
author_facet Damian Bruce-Hickman
Shanaz Matthew Sajeed
Yin Huei Pang
Choon Sheong Seow
Weihao Chen
Monika Gulati Kansal
author_sort Damian Bruce-Hickman
collection DOAJ
description 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.
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issn 2054-4774
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series BMJ Open Gastroenterology
spelling doaj-art-0263cfb18a504b66b690a34c729475872024-12-14T19:00:09ZengBMJ Publishing GroupBMJ Open Gastroenterology2054-47742020-12-017110.1136/bmjgast-2020-000484Bowel ulceration following tocilizumab administration in a COVID-19 patientDamian Bruce-Hickman0Shanaz Matthew Sajeed1Yin Huei Pang2Choon Sheong Seow3Weihao Chen4Monika Gulati Kansal5Intensive Care Medicine, Ng Teng Fong General Hospital, National University Health System, SingaporeIntensive Care Medicine, Ng Teng Fong General Hospital, National University Health System, SingaporeDepartment of Pathology, National University Hospital, SingaporeDepartment of General Surgery, Ng Teng Fong General Hospital, National University Health System, SingaporeGastroenterology and Hepatology, Ng Teng Fong General Hospital, National University Health System, SingaporeIntensive Care Medicine, Ng Teng Fong General Hospital, National University Health System, SingaporeTocilizumab, 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.https://bmjopengastro.bmj.com/content/7/1/e000484.full
spellingShingle Damian Bruce-Hickman
Shanaz Matthew Sajeed
Yin Huei Pang
Choon Sheong Seow
Weihao Chen
Monika Gulati Kansal
Bowel ulceration following tocilizumab administration in a COVID-19 patient
BMJ Open Gastroenterology
title Bowel ulceration following tocilizumab administration in a COVID-19 patient
title_full Bowel ulceration following tocilizumab administration in a COVID-19 patient
title_fullStr Bowel ulceration following tocilizumab administration in a COVID-19 patient
title_full_unstemmed Bowel ulceration following tocilizumab administration in a COVID-19 patient
title_short Bowel ulceration following tocilizumab administration in a COVID-19 patient
title_sort bowel ulceration following tocilizumab administration in a covid 19 patient
url https://bmjopengastro.bmj.com/content/7/1/e000484.full
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