Abstract
A 49-year-old male Japanese patient was admitted to our hospital under the diagnosis of COVID-19 pneumonia. For 5 days before admission, he had experienced various symptoms, including high fever, watery diarrhea, dyspnea, and cough, and he tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid. The patient is a smoker who was on medication for hypertension. A chest computed tomography scan showed bilateral multiple patchy ground-glass opacities. Despite being treated with several therapeutic agents, he still exhibited dyspnea (oxygen saturation [SpO2] in ambient air: 88%), a high fever (axillary temperature: 39 °C), and high blood pressure (148/98 mmHg). Because laboratory data revealed high levels of C-reactive protein (CRP; 2.10 mg/dL) and urinary β2-microglobulin (B2M; 33,683 µg/mL), the anti-interleukin-6 receptor antibody tocilizumab (TCZ; 400 mg) was administered intravenously. One day after injection, he was afebrile. Four days after the TCZ injection, his CRP level dropped to 0.27 mg/dL, B2M level decreased to 3817 µg/mL, and viral load became low. No adverse drug reaction due to TCZ was observed. The patient was discharged 15 days after admission. The early administration of TCZ in this patient prevented the pneumonia and kidney injury caused by COVID-19 from progressing to hyperinflammation syndrome.
Highlights
The epidemic of pneumonia first identified at the end of 2019 was caused by a new coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has phylogenetic similarity to SARS-CoV [1]
Accumulating evidence suggests that a subgroup of patients with severe COVID-19 develop cytokine release syndrome (CRS; known as cytokine storm syndrome), which is characterized by high circulating levels of pro-inflammatory cytokines that result in direct tissue injury, especially in the lungs
He was treated with three different drugs that have been reported as effective against COVID-19, but no beneficial effects from these treatments were observed
Summary
The epidemic of pneumonia first identified at the end of 2019 was caused by a new coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has phylogenetic similarity to SARS-CoV [1]. Accumulating evidence suggests that a subgroup of patients with severe COVID-19 develop cytokine release syndrome (CRS; known as cytokine storm syndrome), which is characterized by high circulating levels of pro-inflammatory cytokines that result in direct tissue injury, especially in the lungs. Tocilizumab (TCZ) is a humanized monoclonal antibody that acts as an inhibitor of both membrane-bound and soluble IL-6 receptor It has been tested as a remedy for CRS associated with COVID-19, and TCZ administration was reported to cause significant clinical improvement in COVID-19 patients with pneumonia requiring a ventilator [11,12]. The present report describes the case of a COVID-19 patient who showed respiratory insufficiency with elevated inflammatory and kidney injury markers and was treated with TCZ to determine if this drug could have a therapeutic effect on a patient with pneumonia and kidney injury
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