Abstract
Background: Severe pneumonia and acute respiratory distress syndrome (ARDS) due to COVID-19 is a challenge for nowadays medical practice. Although there is no clarity in the principal mechanism of lung damage and ARDS development, it has been suggested that one of the main reasons of this pathology is the hyperactivation of the immune system, better known as cytokine storm syndrome. Tocilizumab has been proposed to treat COVID-19 severe cases associated to ARDS. Results & methodology: Here we present two successful cases of tocilizumab administration in two COVID-19 patients with prior administration of antiviral therapy (hydroxychloroquine, azithromycin, lopinavir and ritonavir) with adequate response and resolution of ARDS, septic shock and severe pneumonia within the first 72 h. Discussion & conclusion: This case supports the usage of tocilizumab as an effective therapy in COVID-19 associated cytokine storm syndrome. Further studies should be done in order to assess its effectiveness and security.
Highlights
Severe pneumonia and acute respiratory distress syndrome (ARDS) due to COVID-19 is a challenge for nowadays medical practice
Cytokine storm syndrome is a reality in severe cases of COVID-19
Tocilizumab can be a suitable and effective therapy for severe cases of COVID-19 associated with acute respiratory distress syndrome
Summary
Severe pneumonia and acute respiratory distress syndrome (ARDS) due to COVID-19 is a challenge for nowadays medical practice. Pathophysiology is not completely clear, it has been suggested that in severe cases, a disproportionate immune response might lead to a cytokine storm syndrome (CSS), resulting in damage of the lung parenchyma, pneumonitis, ARDS, viral septic shock and death [3] This being said, tocilizumab, an IL-6 antagonist, has been proposed for treatment in severe cases [4,5]. Inflammatory markers kept rising on the first 2 days after tocilizumab, with later regression of D dimer, ferritin, CRP and LDH Patient improved her clinical condition and was taken out of the ICU on the 12th day of hospitalization and was discharged on the 16th day of hospitalization with low oxygen support (25th day of symptoms onset). Control chest CT showed regression of ground glass opacities with significant improvement (Figure 2B)
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