Tocilizumab, an interleukin-6 inhibitor, may ameliorate the inflammatory manifestations associated with severe coronavirus disease 2019 (COVID-19) and thus improve clinical outcomes. This was a retrospective review of patients with laboratory-confirmed severe COVID-19 who received tocilizumab and completed 14 days of follow up. Twenty-five patients were included, median age was 58 years (interquartile range, 50-63) and the majority were males (92%). Co-morbidities included diabetes mellitus (48%), chronic kidney disease (16%), and cardiovascular disease (12%). Fever (92%), cough (84%), and dyspnea (72%) were the commonest presenting symptoms. All patients received at least two concomitant investigational antiviral agents. Median oral temperature was on day 1, 3, and 7 was 38.0°C, 37.3°C (P = .043), and 37.0°C (P = .064), respectively. Corresponding median C-reactive protein was 193 and 7.9 mg/L (P < .0001) and <6 mg/L (P = .0001). Radiological improvement was noted in 44% of patients by day 7% and 68% by day 14. Nine patients (36%) were discharged alive from intensive care unit and three (12%) died. The proportion of patients on invasive ventilation declined from (84%) at the time of tocilizumab initiation to 60% on day 7 (P = .031) and 28% on day 14 (P = .001). The majority (92%) of patients experienced at least one adverse event.However, it is not possible to ascertain which adverse events were directly related to tocilizumab therapy. In patients with severe COVID-19, tocilizumab was associated with dramatic decline in inflammatory markers, radiological improvement and reduced ventilatory support requirements. Given the study's limitations, the results require assessment in adequately powered randomized controlled trials.

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Viral etiology is not uncommon among those evaluated for CNS infection in Qatar. Clinical outcomes are excellent in this group of patients. Antibiotics and acyclovir are overly used even when a viral etiology is confirmed. There is a need for clinician education regarding etiology and treatment of viral CNS infections.

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Patient: Female, 45Final Diagnosis: Primary pituitary tuberculosisSymptoms: Headache • vomiting • vomitingMedication: —Clinical Procedure: Pituitary biospySpecialty: Endocrinology and MetabolicObjective:Rare diseaseBackground:Primary pituitary tuberculosis (in absence of other organ involvement and constitutional symptoms) is an extremely rare disease with total reported cases in the literature fewer than a hundred. Misdiagnosis as pituitary adenoma is common and late diagnosis can result in a permanent endocrine dysfunction and/or long-term neurologic sequelae.Case Report:We report on the case of a middle-aged woman who presented with severe headache and left third cranial nerve palsy. Magnetic resonance imaging (MRI) revealed a large pituitary tumor invading the left cavernous sinus. The case was initially misdiagnosed as pituitary adenoma. A pituitary biopsy was performed and was suggestive of pituitary tuberculosis. Extensive radiologic investigations did not reveal any evidence of other organ involvement by tuberculosis. She was successfully treated with anti-tuberculous medications.Conclusions:In areas with a high pre-test probability of tuberculosis, pituitary tuberculosis should be included in the differential diagnosis of pituitary tumors in order to avoid unnecessary surgical interventions. Besides being the first histologically-proven primary pituitary tuberculosis case reported from Qatar, the current case is unique in that extensive radiologic investigations did not reveal any evidence of other systemic or pulmonary tuberculosis.