Recovery of COVID-19 Acute Respiratory Distress Syndrome with Tocilizumab: Successful Outcome in Two Critically Ill Patients

Abstract

Background: Severe pneumonia and acute respiratory distress syndrome (ARDS) due to COVID-19 is a challenge for nowadays medical practice. Although there is no clarity in the principal mechanism of lung damage and ARDS development, it has been suggested that one of the main reasons of this pathology is the hyperactivation of the immune system, better known as cytokine storm syndrome. Tocilizumab has been proposed to treat COVID-19 severe cases associated to ARDS. Results & methodology: Here we present two successful cases of tocilizumab administration in two COVID-19 patients with prior administration of antiviral therapy (hydroxychloroquine, azithromycin, lopinavir and ritonavir) with adequate response and resolution of ARDS, septic shock and severe pneumonia within the first 72 h. Discussion & conclusion: This case supports the usage of tocilizumab as an effective therapy in COVID-19 associated cytokine storm syndrome. Further studies should be done in order to assess its effectiveness and security.

Prevalence of opportunistic invasive aspergillosis in COVID‐19 patients with severe pneumonia

“…This hyperinflammatory response has been described in cases of sepsis (between 3.7%–4.3%) and half of the ARDS severe cases 29 . Recent evidence supports the role of IL‐6 as a marker for a more severe disease, 30 and the treatment with Tocilizumab seems to be an excellent choice to treat them 31 . Last but not least, there are published cases of an invasive fungal infection in patients with rheumatoid arthritis treated with Tocilizumab.…”

COVID-19-Pneumonie

“…Als immunmodulatorische Substanzen wurden frühzeitig Tocilizumab als Anti-IL-6- und Anakinra als Anti-IL-1-Rezeptor-Antagonist in Heilversuchen [ 59 – 62 ] eingesetzt. Die Begründung für die Therapie ist die Reduktion der Hyperinflammationsreaktion [ 63 , 64 ].…”

COVID-19-Pneumonie

“…Als immunmodulatorische Substanzen wurde frühzeitig Tocilizumab als Anti-IL-6- und Anakinra als Anti-Il1-Rezeptor-Antagonisten in Heilversuchen [ 61 – 64 ] eingesetzt. Die Rationale für diese Therapie ist die Reduktion der Hyperinflammationsreaktion [ 65 , 66 ].…”