key: cord-0829030-w9hq4kj0 authors: Ye, Wenjing; Lu, Saisai; xue, Ali title: The potential role of TNFα in 2019 novel coronavirus pneumonia date: 2020-05-12 journal: Respir Med Case Rep DOI: 10.1016/j.rmcr.2020.101087 sha: 55497b168b92b8ed5718f75ac9a64ad102789b40 doc_id: 829030 cord_uid: w9hq4kj0 The outbreak of 2019 novel coronavirus has spread rapidly in multiple countries. We report the first case of 2019-nCoV infection in a patient with Ankylosing Spondylitisthe (AS), who was a biological agent (anti-TNFα) user in Wenzhou, China, and describe the clinical course and management of the case. On December 31, 2019, a novel coronavirus infection erupted in Wuhan, China, and spread rapidly 1, 2 . As of March 4, 2020, a total of 80424 cases had been reported in in China, with 2984 fatal cases. But all the 504 cases that reported in Wenzhou, 2 China, only two had a history of rheumatic disease, as we knew. Here we report 1 case of a Ankylosing Spondylitisthe (AS) patient under anti-TNFα therapy infected with 2019 novel coronavirus (2019-nCoV). Written consent was provided from the patient included in this report. The Ruian City People's Hospital institutional review board (IRB) does not require IRB approval for case report describing 1 patient. On January 25, 2020, a 48-year-old male who suffered from fever for 3 days went to local hospital to see a doctor. His highest body temperature reached 39℃, accompanied with chills, cough and fatigue. He disclosed that he had close contact with his son who had returned to Ruian on January 17 from Wuhan, China. Chest radiography, blood routine and 2019-nCoV nucleic acid test was undertaken with suspected novel coronavirus pneumonia (NCP). Only stripes of the lower lobe of the left lung was found by the chest radiography ( Figure. 1a). One day later, the Centers for Disease Control and Prevention (CDC) of Wenzhou confirmed that the patient's oropharyngeal swabs tested positive for 2019-nCoV. On January 28, 2020, the patient was admitted to an airborne-isolation unit at local hospital. The patient had a history of AS for 2 years and using Tumor Necrosis Factor-α (TNF-α)inhibitor to control disease (25mg per times, 8 times for the first month, 4 times for the second month, then reduced to 2 times one month, and recently 1 times every 50 days, the last injection was 50 days ago). In addition, he had a history of hypertriglyceridemia and hypertension, but no history of smoking. The physical 3 examination revealed no obvious abnormalities. After admission, the patient received supplemental oxygen, antiviral (lopinavir and ritonavir tablets, interferon α2β) and antibacterial (moxifloxacin) therapy. On days 2 through 7 of hospitalization, the patient continued to report a nonproductive cough, fatigued and intermittent fevers, followed by abdominal discomfort and diarrhea. Laboratory results on hospital days 2 showed elevated levels This case of report, to our knowledge, is the first case of 2019-nCoV infection in a AS patient who was a regular TNF-α inhibitor user. The dosing interval was a bit longer than usual usage due to low disease activity of AS. We found low incidence of NCP in rheumatic disease patient, and the reason remain unclear. Recent study reported that the pathological of 2019-nCoV manifested with increased CCR4+ Th17 cells which may lead to high levels of cytokine 3 . Some studies also found patients infected with 2019-nCoV had high amounts of cytokine, including IL2, IL10, and TNFα 4 . Pulmonary epithelia damage leading to respiratory distress syndrome (ARDS) can be a consequence of a cytokine storm, consist of IL-1β, 5 TNF 5 . Anti-TNFα may have a protect effect as a decrease in serum TNF-α and IL-1β is associated with decreased lung injury and lethality in rats 6 . And earlier infliximab (anti-TNFα monoclonal antibody) administration is associated with better therapeutic result and prognosis in patient with dermatomyositis with acute interstitial pneumonia 7 . Since no-specific treatment has been recommended for 2019-nCoV infection, anti-TNFα therapy may be a potential treatment for NCP. Despite its anti-inflammation effect, exposed to anti-TNF agent may increase risk of all infections, markedly bacterial and fungal opportunistic infections 8, 9 . This patient had normal levels of cytokine, which may due to his pervious injection of TNFα. But the true role of TNFα in NCP remain unknow, and whether anti-TNF therapy is benefit for NCP need more real world data. In the study, we presented a case of patient with rheumatic disease under anti-TNFα therapy infected with 2019-nCoV. Anti-TNF therapy may have positive effect in NCP. Epidemiological and clinical 6 characteristics of 99 cases of 2019 novel coronavirus pneumonia in wuhan, china: A descriptive study First case of 2019 novel coronavirus in the united states Pathological findings of covid-19 associated with acute respiratory distress syndrome Clinical features of patients infected with 2019 novel coronavirus in wuhan, china Severe acute respiratory syndrome coronavirus envelope protein ion channel activity promotes virus fitness and pathogenesis Effects of a dual inhibitor of tumor necrosis factor-alpha and interleukin-1 on lipopolysaccharide-induced lung injury in rats: Involvement of the p38 mitogen-activated protein kinase pathway Efficacy of infliximab in the treatment for dermatomyositis with acute interstitial pneumonia: A study of fourteen cases and literature review Tuberculosis and biologic therapies: Anti-tumor 7 necrosis factor-alpha and beyond Risk of serious and opportunistic infections associated with treatment of inflammatory bowel diseases The authors declare that they have no conflict of interest.