ABSTRACT
The COVID-19 pandemic has caused serious health and social concerns worldwide. Although the primary target of SARS-CoV-2 is the respiratory tract, SARS-CoV-2 infection also causes extrapulmonary symptoms. Previous articles have reported ischemic colitis in COVID-19 patients; however, information regarding its clinical manifestations and pathophysiology is limited. In this case report, we present two cases of ischemic enterocolitis in COVID-19 patients and review past case reports. Our literature review has shown that computed tomography rather than endoscopy was used for the diagnosis, and any region of the intestine was affected. Because the elevation of the D-dimer, which suggested a hypercoagulable state, was reported in most cases, we assumed that thrombosis at any level in the artery and vein was involved in the pathophysiology of COVID-19-associated enterocolitis. SARS-CoV-2-induced endotheliitis can cause both coarctation of the vessels and thrombosis; therefore, both patterns of ischemic colitis, occlusive and nonocclusive, may be involved in COVID-19-associated enterocolitis.
Subject(s)
COVID-19/complications , Colitis, Ischemic/etiology , Enterocolitis/etiology , SARS-CoV-2 , Aged , Female , Humans , Male , Middle AgedABSTRACT
Anticoagulation plays a major role in reducing the risk of systematic thrombosis in patients with severe COVID-19. Serious hemorrhagic complications, such as intracranial hemorrhage, have also been recognized. However, intra-abdominal hemorrhage is under-recognized because of its rare occurrence, despite high mortality. Here, we discuss two cases of spontaneous iliopsoas hematoma (IPH) likely caused by anticoagulants during the clinical course of COVID-19. We also explored published case reports to identify clinical characteristics of IPH in COVID-19 patients. The use of anticoagulants may increase the risk of lethal IPH among COVID-19 patients becsuse of scarce data on optimal dosage and adequate monitoring of anticoagulant effects. Rapid diagnosis and timely intervention are crucial to ensure good patient outcomes.
Subject(s)
Abscess/virology , COVID-19/complications , Hematoma/diagnosis , Hematoma/virology , Muscle, Skeletal/pathology , Abscess/classification , Abscess/diagnosis , Aged , Anticoagulants/adverse effects , Antiviral Agents/therapeutic use , Blood Coagulation , COVID-19/diagnostic imaging , Fatal Outcome , Hematoma/classification , Hematoma/drug therapy , Humans , Male , Middle Aged , Muscle, Skeletal/virology , Severity of Illness Index , Thigh/pathology , Tomography, X-Ray Computed , Treatment Outcome , COVID-19 Drug TreatmentSubject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19 Drug Treatment , Cytokine Release Syndrome/drug therapy , Interleukin-6/antagonists & inhibitors , Respiratory Distress Syndrome , Cytokine Release Syndrome/virology , Humans , Japan/epidemiology , Respiratory Distress Syndrome/drug therapy , Respiratory Distress Syndrome/virologyABSTRACT
Treatment with tocilizumab (TCZ) to block interleukin-6 (IL-6) signalling is predicted to mitigate cytokine release syndrome (CRS) caused by coronavirus disease 2019 (COVID-19). However, the adverse effects of TCZ on patients with COVID-19 remain unclear. We herein report a patient with COVID-19 treated with TCZ who developed acute hypertriglyceridaemia. Despite favipiravir treatment, acute respiratory distress syndrome developed in a 45-year-old patient with COVID-19; thus, TCZ was initiated. The triglyceride levels greatly increased after TCZ administration. Physicians should consider the negative impact of TCZ on the lipid profile in patients with COVID-19, although COVID-19-induced CRS itself may be an aggravating factor.