How to follow-up a patient who received tocilizumab in severe COVID-19: a case report

European Journal of Medical Research

Hanna Czeszko-Paprocka¹  Andrzej Horban²  Justyna D. Kowalska²  Beata Wojtycha-Kwaśnica³  Regina B. Podlasin⁴  Magdalena Thompson⁴  Andrzej Pihowicz⁵  Tomasz Dyda⁶ 

[1] Central Analytical Laboratory, Hospital for Infectious Diseases in Warsaw;Department of Adults’ Infectious Diseases, Medical University of Warsaw;Department of Diagnostic Imaging, Hospital for Infectious Diseases in Warsaw;IV-th Department, Hospital for Infectious Diseases;Intensive Care Unit, Hospital for Infectious Diseases in Warsaw;Molecular Diagnostics Laboratory, Hospital for Infectious Diseases in Warsaw;

关键词: SARS-CoV-2;    COVID-19;    Tocilizumab;    Chloroquine;    ARDS;    Cytokine storm;   

DOI  :  10.1186/s40001-020-00438-x

来源: DOAJ

【 摘 要 】

Abstract Background COVID-19 is characterized by fast deterioration in the mechanism of cytokine storm. Therefore, treatment with immunomodulating agents should be initiated as soon as hyperinflammation is established. Evidence for the use of tocilizumab (TCZ) in COVID-19 is emerging, but the drug in this setting is used “off label” with limited data on both effectiveness and safety. Therefore, Hospital for Infectious Diseases in Warsaw established a Standard Operating Procedure (SOP) for the use of TCZ in severe COVID-19 cases. Case presentation Here, we present a case of 27-year-old, otherwise healthy man, who was successfully treated with chloroquine, azithromycin, tocilizumab and a standard of care. Initially the magnitude of lung devastation, clinical deterioration and the need for mechanical ventilation suggested unfavorable prognosis. However, we observed complete regression in radiological changes and rapid clinical improvement. Irrespective of this, patient’s serum interleukin 6 and aminotransferases remained elevated even after a month from treatment. Conclusions An overlapping effect of hyperinflammation, hypoxic organ injury and drug-related toxicity warrants a long-term follow-up for COVID-19 survivors. In addition, residual IL-6 receptors blockage may mask new infections. A standardized approach to follow-up for COVID-19 survivors is urgently needed. Current and future research should also investigate the impact of experimental therapies on lung tissue healing and regeneration, as well as long-term treatment toxicities.

【 授权许可】

Unknown