Cecal Perforation in a COVID-19 Patient Treated with Tocilizumab: A Case Report

Review Data

Q: Is the topic relevant to the journal area of interest? Is it contemporary and interesting for

researchers?

A: Good

Abstract & Keywords

Q: Are all required components included in the abstract? Are the keywords appropriately chosen?

A: Good

Goal

Q: Is the goal explicitly stated in the Introduction? Is its formulation clear and unambiguous?

A: Very Good

Structure

Q: Is the paper's structure coherent? Is it in coherence with the goal of the paper?

A: Good

Comment: The paragraph under Summary is best suited as Abstract. Thus, the subheading Summary should be changed to Abstract.

Tools and Methods

Q: Are methods the author uses adequate and well used?

A: Good

Discussion & Conclusion

Q: Is it related to the results presented before? Do you consider them as coherent?

A: Good

Comments: The Discussion establishes that gastrointestinal perforation (GIP) is a rare but severe complication related to Tocilizumab treatment and no increase in incidence has been observed with higher drug doses nor longer drug exposure time. Perforations usually occur in the lower gastrointestinal tract. The Discussion highlights that the study was not able to determine to what extent both Tocilizumab and high doses of glucocorticoids had contributed to the pathogenesis of GIP in this case. However, Tocilizumab may have caused the transmural inflammatory progression and the subsequent intestinal perforation. Relevant literature has been cited to support the discussion. The study concludes that with increase in use of Tocilizumab to treat patients with severe COVID-19 pneumonia an increase in the incidence of GIP related to Tocilizumab may be observed.

Literature

Q: Does the author utilize relevant literature?

A: Good

Author's knowledge

Q: What is the level of the author’s knowledge? Does the author utilize all recent contributions relevant to the topic?

A: Good

Length

Q: Is the length of the paper adequate to the significance of the topic? Do you suggest shortening the paper without losing its value?

A: Good

Figures & Tables

Q: Does the author use them suitably? Are legend and notations clear?

A: Good

Writing style

Q: Is it clear and understandable?

A: Good

Comments: Except the following error has been detected:

1.     The full form of the abbreviation “NSAID” has not been mentioned in the text part of the manuscript.

Further comments on the paper

Comments: The case report presents the case of gastrointestinal perforation (GIP) in a 74-year-old female COVID-19 patient who was treated with Tocilizumab. The patient was presented with anorexia, constipation and was in an acute confusional state. Tocilizumab, a monoclonal antibody against the interleukin-6 receptor, is being used to treat patients with severe COVID-19 pneumonia. The patient suffered from GIP 7 days after administration of Tocilizumab. A cecal perforation of inflammatory aspect was observed using exploratory laparotomy. Right hemicolectomy with terminal ileostomy and the mucous fistula was performed. The postoperative period was uneventful and no signs of malignancy were observed. The study concludes that with increase in use of Tocilizumab as an alternative treatment for patients with severe COVID-19 pneumonia there might be a rise in the incidence of GIP related to Tocilizumab.

Q: Would you recommend this manuscript for further publication?

A: Yes - Suitable to be published

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Science Repository Team