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

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

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


This case series reviews four critically ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-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.

Original languageEnglish
Article number638075
JournalFrontiers in Medicine
Publication statusPublished - 4 Jun 2021
Externally publishedYes


  • COVID-19
  • IL-6 inhibitor
  • ischemia-reperfusion injury
  • mesenteric ischemia
  • molecular targeted therapy
  • pneumatosis intestinalis
  • SARS-CoV-2
  • tocilizumab


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