COVID-19 Induced Cardiomyopathy Successfully Treated with Tocilizumab

Abstract

Background. Currently, the literature regarding the management of COVID-19 induced cardiomyopathy with reduced ejection fraction is limited. In this case report, we present the first documented case of COVID-19 induced myocardial stunning leading to severely reduced LV systolic function that was reversed by the administration of corticosteroids and tocilizumab. Case Summary. A 39-year-old female with well controlled systemic hypertension, tested positive for SARS-CoV-2 RNA and underwent self-isolation for 14 days. Patient presented to our facility a month later with one-week history of progressively worsening generalized body aches, chills, fever, watery diarrhea, nausea with associated mild dry nonproductive cough, shortness of breath and nonspecific chest pain. Initial labs demonstrated that she was COVID-19 positive, elevated troponin (4.295 ng/ml), and elevated BNP (2,291 pg/ml). Her initial Transthoracic echocardiography demonstrated an Left ventricular ejection fraction (LVEF) of 20-25% with apical akinesis. After administration of tocilizumab and corticosteroids, patient demonstrated interval improvement with LVEF improving to 50-55% within days. Her labs confirmed these findings with improved troponin (0.858 ng/ml) and BNP (209 pg/ml). Discussion. This case demonstrates that it can be safe and efficacious to use tocilizumab and corticosteroids in patients with COVID-19 induced cardiomyopathy. These finding suggest that cytokine storm is the predominant mechanism by which COVID-19 induced cardiomyopathy occurs. Additional studies are required to determine the role of corticosteroids and tocilizumab in management of this condition.

A Bioinformatic Approach Based on Systems Biology to Determine the Effects of SARS-CoV-2 Infection in Patients with Hypertrophic Cardiomyopathy

“…Additionally, testosterone administration helps suppress the inflammatory response [ 69 ] and modulates the immune response, which would be more significant in female patients. We witnessed the first case of corticosteroid and tocilizumab application in reversing the severely reduced left ventricular systolic function due to myocardial depression caused by COVID-19 [ 70 ]. This partially demonstrates the clinical viability of our candidate drugs in patients with HCM and paves the way for future pharmaceutical studies.…”

Adjuvants in COVID-19 vaccines: innocent bystanders or culpable abettors for stirring up COVID-heart syndrome

“… 10 On the other hand, COVID-19 virus due to its inherent baneful potency can provoke these cardiovascular abnormalities via cytokine storm, sepsis, autoimmunity, molecular mimicry, and direct cardiomyocyte invasion. 10 – 13 …”

Impact of COVID-19 on Cardiovascular Disease

“…Thus, CV safety has been demonstrated for tocilizumab treatment in non-COVID patients. Interestingly, when analyzing tocilizumab treatment in COVID-19 patients, some case reports described a reversal of cardiac dysfunction and clinical improvement in patients with severe acute HF without coronary obstruction after the administration of tocilizumab, indicating a possible beneficial effect of this treatment in COVID-19 patients with associated cardiac dysfunction [ 191 , 192 ]. Of note though, Alattar and colleagues evaluated 25 critically ill COVID-19 patients who received tocilizumab and found a QT prolongation in five cases (20%).…”