Furthermore, critically ill COVID-19 patients may have altered hemodynamics, potentially leading to intestinal hypoperfusion that can compromise intestinal mucosal integrity. More studies are required to evaluate whether these variables influence the risk of intestinal perforation with tocilizumab in critical COVID-19 cases; however, clinicians should be aware of the potential for this adverse event. Lastly, as tocilizumab attenuates the acute phase response, intestinal perforation may not necessarily cause significant C-reactive protein (CRP) elevation and may initially go unnoticed in sedated and ventilated patients.