Abstract
The coronavirus disease 2019 (COVID-19) pandemic is now a major global health threat. More than half a year have passed since the first discovery of severe acute respiratory syndrome coronavirus-2 (SARS-CoV2), no effective treatment has been established especially in intensive care unit. Inflammatory cytokine storm caused by SARS-CoV-2 infection has been reported to play a central role in COVID-19; therefore, treatments for suppressing cytokines, including extracorporeal treatments, are considered to be beneficial. However, until today the efficacy of removing cytokines by extracorporeal treatments in patients with COVID-19 is unclear. Herein, we report our experience with a 66-year-old male patient undergoing maintenance peritoneal dialysis who became critically ill with COVID-19 and underwent several extracorporeal treatment approaches including plasma exchange, direct hemoperfusion using a polymyxin B-immobilized fiber column and continuous hemodiafiltration. Though the patient developed acute respiratory distress syndrome (ARDS) repeatedly and subacute cerebral infarction and finally died for respiratory failure on day 30 after admission, these attempts appeared to dampen the cytokine storm based on the observed decline in serum IL-6 levels and were effective against ARDS and secondary haemophagocytic lymphohistiocytosis. This case suggests the significance of timely initiation of extracorporeal treatment approaches in critically ill patients with COVID-19.
Highlights
Since the diagnosis of the first patient in December 2019 in Wuhan, China, coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, has evolved into a pandemic [1]
His symptoms worsened in the absence of evidence for bacterial or fungal infection; he was considered to have developed sHLH due to an uncontrolled cytokine storm caused by COVID-19, his serum interleukin 6 (IL-6) levels were not determined after the development of sHLH
There are no confirmed treatment approaches for COVID-19, a combined approach by controlling viral replication and suppressing the cytokine storm is considered as an important therapeutic strategy for COVID-19
Summary
Since the diagnosis of the first patient in December 2019 in Wuhan, China, coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, has evolved into a pandemic [1]. The nasopharyngeal swab sample was positive for SARS-CoV-2 by quantitative polymerase chain reaction (qPCR), and the patient was diagnosed with COVID-19 He required intubation and mechanical ventilation on day one because of worsening hypoxemia and admitted to the intensive care unit for further evaluation and management. Starting on day 11, he developed sHLH based on the presence of fever, thrombocytopenia and elevated levels of ferritin, lactate dehydrogenase His symptoms worsened in the absence of evidence for bacterial or fungal infection; he was considered to have developed sHLH due to an uncontrolled cytokine storm caused by COVID-19, his serum IL-6 levels were not determined after the development of sHLH.
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