COVID-19 Induced Cytokine Storm Manifesting as Takatsubo Cardiomyopathy and Sepsis Reversed with Therapeutic Plasma Exchange

Abstract

The pathophysiology of severe COVID-19 involves a hyperactive immune response often referred to as cytokine storm. This pathway may lead to different clinical phenotypes including acute respiratory distress syndrome, sepsis, cardiomyopathy, and/or multiple organ failure. Therapeutic plasma exchange (TPE) has been proposed as adjunct treatment for sepsis and cytokine storm with case reports and small trials showing clinical success. We present a case of Takotsubo cardiomyopathy with refractory cardiogenic shock that reversed following TPE. Our patient subsequently developed sepsis and again responded clinically to TPE. This case offers an exciting anecdotal outcome while generating hypotheses for further clinical research.