key: cord-0981465-z4pccarh
authors: Chen, Yen‐Wen; Liao, Hsien‐Tzung
title: Tocilizumab alleviates cytokine storm with acute respiratory distress syndrome in severe SARS‐CoV‐2 infection in Taiwan
date: 2021-09-19
journal: Intern Med J
DOI: 10.1111/imj.15335
sha: d4242260b298c449efd83cf56b12e0bae3f18a66
doc_id: 981465
cord_uid: z4pccarh

nan

Tocilizumab alleviates cytokine storm with acute respiratory distress syndrome in severe SARS-CoV-2 infection in Taiwan

The coronavirus disease-2019 (COVID-19) is a catastrophic state involving various organs mediated by massive sequential proinflammatory cytokines. The pathophysiology of severe SARS-CoV-2 infectioninduced respiratory distress and cytokine release syndrome was similar to the SARS outbreak in 2003. The sequential fulminant cytokine storm results in fatal and permanent damage of vital organs. Serum interleukin (IL)-6 concentration in COVID-19 was proven to have good predictive accuracy for intubation/mortality and oxygen requirement. 1 Therefore, treatment strategies in these critical patients with COVID-19 should combine adequate antibiotics and anti-cytokine therapy simultaneously, 2,3 although the effect of IL-6 blockade or Janus kinase inhibitor for COVID-19 is still inconclusive. [4] [5] [6] In real-world clinical practice, we had a successful experience in the use of tocilizumab (a monoclonal antibody to IL-6 receptor) in one critical and catastrophically ill Taiwanese female patient who suffered from a severe SARS-CoV-2 infection with a high serum level of IL-6.

A 75-year-old Taiwanese woman travelled to South America and Europe and was quarantined in hospital due to being confirmed positive for SARS-CoV-2 infection. Unfortunately, rapidly progressive dyspnoea with unstable haemodynamics ensued within a few days that prompted endotracheal intubation, mechanical ventilation and venovenous-extracorporeal membrane oxygenation (VV-ECMO). Broad spectrum antibiotics were given. However, bilateral pulmonary consolidation occurred (Fig. 1A) with deteriorating hypoxaemia resulting in acute respiratory distress syndrome. Serum IL-6 concentration revealed was four times normal and we administered tocilizumab 8 mg/kg intravenously. Amazingly, the respiratory distress and shock dramatically improved, as evidenced by clearing of the radiological consolidation (Fig. 1B) and improvement in hypoxia 24 h thereafter. Two to three weeks later, she was successfully extubated and weaned successfully from VV-ECMO and was discharged from hospital (Fig. 1C) .

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