Tocilizumab in Severe COVID-19 Pneumonia and Concomitant Cytokine Release Syndrome

Tom DA van Kraaij; Rémy Lm Mostard; Sofia Ramiro; Cesar Magro Checa; Christel Mp van Dongen; Eric Hj van Haren; Jacqueline Buijs; Robert Bm Landewé

doi:10.12890/2020_001675

Tocilizumab in Severe COVID-19 Pneumonia and Concomitant Cytokine Release Syndrome

Eur J Case Rep Intern Med. 2020 Apr 22;7(5):001675. doi: 10.12890/2020_001675. eCollection 2020.

Authors

Tom DA van Kraaij¹, Rémy Lm Mostard¹, Sofia Ramiro^{2

3}, Cesar Magro Checa², Christel Mp van Dongen², Eric Hj van Haren¹, Jacqueline Buijs⁴, Robert Bm Landewé^{2

5}

Affiliations

¹ Department of Pulmonology, Zuyderland Medical Center, Heerlen-Sittard, the Netherlands.
² Department of Rheumatology, Zuyderland Medical Center, Heerlen-Sittard, the Netherlands.
³ Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.
⁴ Department of Internal Medicine, Zuyderland Medical Center, Heerlen-Sittard, the Netherlands.
⁵ Department of Rheumatology, Amsterdam University Medical Center (ARC), Amsterdam, the Netherlands.

Abstract

Younger patients with COVID-19 may experience an exaggerated immune response to SARS-CoV-2 infection and develop cytokine release syndrome (CRS), which may be life threatening. There is no proven antiviral therapy for COVID-19 so far, but profound immunosuppression has recently been suggested as a treatment for COVID-19-associated CRS. We present a case of life-threatening CRS caused by COVID-19 infection with a favourable response to immunosuppressive therapy with tocilizumab (TCZ). The rapid clinical and biochemical improvement following TCZ administration suggests that treatment with immunotherapy can be life-saving in selected patients with COVID-19-induced CRS.

Learning points: Cytokine release syndrome may cause sudden and potentially life-threatening clinical deterioration in COVID-19 pneumonia, particularly in younger patients.Immunosuppressive therapy may provide important additional therapeutic benefit in these patients.Tocilizumab, a specific IL-6 inhibitor, led to dramatic clinical improvement in a young patient with severe COVID-19-associated cytokine release syndrome.

Keywords: COVID-19; cytokine release syndrome; tocilizumab.