Occult Colonic Perforation in a Patient With Coronavirus Disease 2019 After Interleukin-6 Receptor Antagonist Therapy.
Occult Colonic Perforation in a Patient With Coronavirus Disease 2019 After Interleukin-6 Receptor Antagonist Therapy.
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DOI：
10.1093/ofid/ofaa424
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发表时间：
2020-11
影响因子：
4.2
通讯作者：
Salehi-Rad R
中科院分区：
文献类型：
--
作者：
Schwab K;Hamidi S;Chung A;Lim RJ;Khanlou N;Hoesterey D;Dumitras C;Adeyiga OB;Phan-Tang M;Wang TS;Saggar R;Goldstein J;Belperio JA;Dubinett SM;Kim JT;Salehi-Rad R
白介素6阻断(IL-6)已成为冠状病毒病2019年(新冠肺炎)治疗研究的重点。我们报告一位34岁新冠肺炎肺炎患者，接受IL-6受体拮抗剂(IL-6RA)治疗，继而发展为自发性结肠穿孔。尽管进行了良性的腹部检查，并且没有其他已知的与结肠穿孔相关的危险因素，但穿孔还是发生了。电子显微镜检查发现许多完整的严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)病毒颗粒与结肠粘膜的微绒毛毗邻。多重免疫荧光染色显示，在表达血管紧张素转换酶2的结肠细胞刷状缘处存在SARS-CoV-2刺突蛋白。但在肠细胞内没有观察到病毒颗粒，表明病毒直接损伤是结肠穿孔的原因。这些数据和自发性结肠穿孔的已知危险因素的缺乏表明IL-6RA治疗是该病例中结肠损伤的潜在介体。此外，这份报告提供了首次在出现结肠穿孔的患者的结肠中发现病毒的现场可视证据，进一步证明粪便中可以存在完整的传染性病毒。
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.
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影响因子：
64.8
作者：
Taniguchi, Koji;Wu, Li-Wha;Grivennikov, Sergei I.;de Jong, Petrus R.;Lian, Ian;Yu, Fa-Xing;Wang, Kepeng;Ho, Samuel B.;Boland, Brigid S.;Chang, John T.;Sandborn, William J.;Hardiman, Gary;Raz, Eyal;Maehara, Yoshihiko;Yoshimura, Akihiko;Zucman-Rossi, Jessica;Guan, Kun-Liang;Karin, Michael
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Karin, Michael
影响因子：
56.9
作者：
Lamers, Mart M.;Beumer, Joep;Clevers, Hans
通讯作者：
Clevers, Hans
影响因子：
51.1
作者：
Hapani, Sanjaykumar;Chu, David;Wu, Shenhong
通讯作者：
Wu, Shenhong
影响因子：
7.3
作者：
Hamming, I;Timens, W;van Goor, H
通讯作者：
van Goor, H
影响因子：
27.4
作者：
Strangfeld A;Richter A;Siegmund B;Herzer P;Rockwitz K;Demary W;Aringer M;Meißner Y;Zink A;Listing J
通讯作者：
Listing J