{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T19:29:42Z","timestamp":1780514982787,"version":"3.54.1"},"reference-count":12,"publisher":"The Pediatric Pharmacy Association","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:p>Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune central nervous system disease with inflammatory events recurring in the optic nerves and spinal cord. Neuromyelitis optica (NMO) is rare in children, and pediatric patients typically present with optic neuritis following infections. Lack of response to pulse-dose intravenous corticosteroids or recurrent relapse episodes warrant therapies such as plasma exchange, intravenous immunoglobulin (IVIG), and rituximab. In adult studies, tocilizumab has been used and found to reduce NMO relapse; however, limitations exist in the pediatric population due to the lack of studies and formal treatment guidelines. Gastrointestinal perforation (GIP) is a rare, life-threatening complication identified in clinical trials during tocilizumab therapy. We report a case of a fatal, infected GIP following a single dose of tocilizumab for refractory NMO in a 15-year-old male. This case highlights the need for more outcomes data when using tocilizumab to treat pediatric NMO. Additionally, an assessment of patient-specific risk factors should be outlined to better direct safe therapy and to minimize negative adverse outcomes.<\/jats:p>","DOI":"10.5863\/1551-6776-30.2.258","type":"journal-article","created":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T14:48:28Z","timestamp":1745246908000},"page":"258-262","source":"Crossref","is-referenced-by-count":2,"title":["Aspergillus-Infected Duodenal Perforations Following a Single Dose of Tocilizumab for Pediatric Neuromyelitis Optica"],"prefix":"10.5863","volume":"30","author":[{"given":"Esther L.","family":"Albuquerque","sequence":"first","affiliation":[{"name":"College of Pharmacy (ELA, DJ, SEK, MV), The University of Texas at Austin, Austin, TX"},{"name":"Pharmacotherapy Education and Research Center (ELA, SEK, MV), The University of Texas Health Science Center at San Antonio, San Antonio, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damaris","family":"Jacota","sequence":"additional","affiliation":[{"name":"College of Pharmacy (ELA, DJ, SEK, MV), The University of Texas at Austin, Austin, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Vu","sequence":"additional","affiliation":[{"name":"College of Pharmacy (ELA, DJ, SEK, MV), The University of Texas at Austin, Austin, TX"},{"name":"Department of Pharmacotherapy and Pharmacy Services (SEK, MV), University Health, San Antonio, TX"},{"name":"Pharmacotherapy Education and Research Center (ELA, SEK, MV), The University of Texas Health Science Center at San Antonio, San Antonio, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah E.","family":"Kubes","sequence":"additional","affiliation":[{"name":"College of Pharmacy (ELA, DJ, SEK, MV), The University of Texas at Austin, Austin, TX"},{"name":"Department of Pharmacotherapy and Pharmacy Services (SEK, MV), University Health, San Antonio, TX"},{"name":"Pharmacotherapy Education and Research Center (ELA, SEK, MV), The University of Texas Health Science Center at San Antonio, San Antonio, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3883","reference":[{"issue":"(9 suppl 2)","key":"i2331-348X-30-2-258-b01","series-title":"Neurology","first-page":"S59","article-title":"Neuromyelitis optica spectrum disorders in children and adolescents","volume":"87","author":"Tenembaum","year":"2016","unstructured":"Tenembaum S, Chitnis T, Nakashima I, et al. Neuromyelitis optica spectrum disorders in children and adolescents. Neurology. 2016;87(9 suppl 2):S59\u2013S66."},{"issue":"(5)","key":"i2331-348X-30-2-258-b02","series-title":"Cell Biol Int","first-page":"848","article-title":"COVID-19: a trigger of autoimmune diseases","volume":"47","author":"Zebardast","year":"2023","unstructured":"Zebardast A, Hasanzadeh A, Ebrahimian Shiadeh SA, et al. COVID-19: a trigger of autoimmune diseases. Cell Biol Int. 2023;47(5):848\u2013858."},{"key":"i2331-348X-30-2-258-b03","series-title":"Mult Scler Relat Disord","first-page":"103697","article-title":"Post COVID-19 infection neuromyelitis optica spectrum disorder (NMOSD): a case report-based systematic review","volume":"60","author":"Mirmosayyeb","year":"2022","unstructured":"Mirmosayyeb O, Ghaffary EM, Bagherieh S, et al. Post COVID-19 infection neuromyelitis optica spectrum disorder (NMOSD): a case report-based systematic review. Mult Scler Relat Disord. 2022;60:103697."},{"issue":"(5)","key":"i2331-348X-30-2-258-b04","series-title":"Lancet Neurol","first-page":"391","article-title":"Safety and efficacy of tocilizumab versus azathioprine in highly relapsing neuromyelitis optica spectrum disorder (TANGO): an open-label, multicentre, randomised, phase 2 trial","volume":"19","author":"Zhang","year":"2020","unstructured":"Zhang C, Zhang M, Qiu W, et al. Safety and efficacy of tocilizumab versus azathioprine in highly relapsing neuromyelitis optica spectrum disorder (TANGO): an open-label, multicentre, randomised, phase 2 trial. Lancet Neurol. 2020;19(5):391\u2013401."},{"issue":"(3)","key":"i2331-348X-30-2-258-b05","series-title":"J Med Cases","first-page":"135","article-title":"Tocilizumab-associated small bowel perforation in a young patient with rheumatoid arthritis: a lesson to remember during COVID-19 pandemic","volume":"13","author":"Saad","year":"2022","unstructured":"Saad E, Awadelkarim A, Agab M, Babkir A. Tocilizumab-associated small bowel perforation in a young patient with rheumatoid arthritis: a lesson to remember during COVID-19 pandemic. J Med Cases. 2022;13(3):135\u2013139."},{"key":"i2331-348X-30-2-258-b06","year":"2017","unstructured":"Actemra (tocilizumab) injection [package insert]. San Francisco, CA: Genentech Inc; 2017."},{"issue":"(11)","key":"i2331-348X-30-2-258-b07","series-title":"Arthritis Rheumatol","first-page":"2612","article-title":"Brief report: risk of gastrointestinal perforation among rheumatoid arthritis patients receiving tofacitinib, tocilizumab, or other biologic treatments","volume":"68","author":"Xie","year":"2016","unstructured":"Xie F, Yun H, Bernatsky S, Curtis JR. Brief report: risk of gastrointestinal perforation among rheumatoid arthritis patients receiving tofacitinib, tocilizumab, or other biologic treatments. Arthritis Rheumatol. 2016;68(11):2612\u20132617."},{"issue":"(03)","key":"i2331-348X-30-2-258-b08","series-title":"Neuropediatrics","first-page":"193","article-title":"Two cases of pediatric AQP4-antibody positive neuromyelitis optica spectrum disorder successfully treated with tocilizumab","volume":"50","author":"Breu","year":"2019","unstructured":"Breu M, Glatter S, H\u00f6ftberger R, Freilinger M, et al. Two cases of pediatric AQP4-antibody positive neuromyelitis optica spectrum disorder successfully treated with tocilizumab. Neuropediatrics. 2019;50(03):193\u2013196."},{"key":"i2331-348X-30-2-258-b09","series-title":"Front Neurol","first-page":"1099758","article-title":"New onset or relapsing neuromyelitis optica temporally associated with SARS-CoV-2 infection and COVID-19 vaccination: a systematic review","volume":"14","author":"Harel","year":"2023","unstructured":"Harel T, Gorman EF, Wallin MT. New onset or relapsing neuromyelitis optica temporally associated with SARS-CoV-2 infection and COVID-19 vaccination: a systematic review. Front Neurol. 2023;14:1099758."},{"issue":"(9)","key":"i2331-348X-30-2-258-b10","series-title":"Rheumatology (Oxford)","first-page":"1713","article-title":"Multiple upper gastrointestinal perforations in a 15-year-old patient treated with tocilizumab","volume":"53","author":"Pfeil","year":"2014","unstructured":"Pfeil J, Grulich-Henn J, Wenning D, et al. Multiple upper gastrointestinal perforations in a 15-year-old patient treated with tocilizumab. Rheumatology (Oxford). 2014;53(9):1713\u20131714."},{"issue":"(2)","key":"i2331-348X-30-2-258-b11","series-title":"Clin Pharmacokinet","first-page":"155","article-title":"Pharmacokinetic\/pharmacodynamic considerations of alternate dosing strategies of tocilizumab in COVID-19","volume":"61","author":"Leung","year":"2022","unstructured":"Leung E, Crass RL, Jorgensen SCJ, et al. Pharmacokinetic\/pharmacodynamic considerations of alternate dosing strategies of tocilizumab in COVID-19. Clin Pharmacokinet. 2022;61(2):155\u2013165."},{"issue":"(6)","key":"i2331-348X-30-2-258-b12","series-title":"Drug Saf","first-page":"545","article-title":"Gastrointestinal perforations with biologics in patients with rheumatoid arthritis: implications for clinicians","volume":"41","author":"Jagpal","year":"2018","unstructured":"Jagpal A, Curtis JR. Gastrointestinal perforations with biologics in patients with rheumatoid arthritis: implications for clinicians. Drug Saf. 2018;41(6):545\u2013553."}],"container-title":["The Journal of Pediatric Pharmacology and Therapeutics"],"original-title":[],"link":[{"URL":"https:\/\/jppt.kglmeridian.com\/view\/journals\/jppt\/30\/2\/article-p258.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/jppt.kglmeridian.com\/downloadpdf\/journals\/jppt\/30\/2\/article-p258.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jppt.kglmeridian.com\/downloadpdf\/journals\/jppt\/30\/2\/article-p258.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T14:48:28Z","timestamp":1745246908000},"score":1,"resource":{"primary":{"URL":"https:\/\/jppt.kglmeridian.com\/view\/journals\/jppt\/30\/2\/article-p258.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4]]},"references-count":12,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.5863\/1551-6776-30.2.258","relation":{},"ISSN":["2331-348X","1551-6776"],"issn-type":[{"value":"2331-348X","type":"electronic"},{"value":"1551-6776","type":"print"}],"subject":[],"published":{"date-parts":[[2025,4]]}}}