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1.
Rev. bras. anal. clin ; 53(2): 180-182, 20210630. ilus
Article in Portuguese | LILACS | ID: biblio-1352922

ABSTRACT

Desde o primeiro caso de COVID-19, ocorrido na China em dezembro de 2019, o espec- tro da doença tem se mostrado muito amplo, incluindo uma miríade de manifestações hematológicas. Relatamos aqui o caso de um paciente com diagnóstico confirmado de COVID-19, o qual apresentou, no sangue periférico, a presença de hemácias apresentan- do projeções citoplasmáticas, semelhantes a uma célula pinçada (pincer cells), também conhecidas como hemácias em forma de cogumelo (mushroom-shaped red blood cells).


Since the first case of COVID-19, which occurred in China in December 2019, the spectrum of the disease has been very broad, including a myriad of hematological manifestations. We report here the case of a patient with a confirmed diagnosis of COVID-19, who presented, in peripheral blood, the red blood cells with cytoplasmic projections, similar to a pincer cells, also known as mushroom-shaped red blood cells.


Subject(s)
Humans , Male , Adult , Oxidative Stress , SARS Virus , Erythrocytes , Cytokine Release Syndrome , COVID-19
2.
Rev. cuba. invest. bioméd ; 40(2): e1014, 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1347464

ABSTRACT

Introducción. La COVID-19 es la enfermedad causada por el virus SARS-CoV-2. Aunque la mayoría de los pacientes presentan síntomas leves o moderados, un 5 por ciento desarrolla un síndrome respiratorio severo. Conocer la dinámica de la respuesta inmune en la infección por SARS-CoV-2 es esencial para el manejo adecuado de los pacientes. Objetivo. Describir los elementos esenciales de la dinámica de la respuesta inmune a la infección por SARS-CoV-2. Métodos: Se realizó una revisión de la literatura actualizada en bases de datos bibliográficas. Se consultaron 40 publicaciones. Se analizó la calidad y fiabilidad de los artículos seleccionados. Análisis e integración de la información: Durante los momentos iniciales de la respuesta inmune al SARS-CoV-2 predominan mecanismos innatos de defensa encaminados a eliminar el virus e impedir el avance de la enfermedad hacia la severidad. Si el sistema inmune no logra erradicar el virus ocurre una desregulación inmune que produce un daño importante por inflamación tisular. La inmunoterapia debe enfocarse en estimular la primera etapa (protectora) y suprimir la segunda. Una respuesta inmune adecuada es vital en el enfrentamiento a las infecciones por coronavirus. Conclusiones. La dinámica de la respuesta antiviral en los infectados por SARS-CoV-2 es uno de los elementos esenciales que condicionan la severidad de la enfermedad. La aparición de la tormenta de citocinas, producto de una desregulación inmune, se ha presentado como causa primaria del síndrome respiratorio severo observado en estos pacientes. Un mayor conocimiento de los mecanismos inmunopatogénicos es imprescindible para el desarrollo de medicamentos con alta eficacia.(AU)


Introduction: COVID-19 is the disease caused by the SARS-CoV-2 virus. Though most patients present mild or moderate symptoms, 5 percent develop severe respiratory syndrome. Awareness of the dynamics of the immune response to SARS-CoV-2 infection is essential for the appropriate management of patients. Objective: Describe the essential elements of the dynamics of the immune response to SARS-CoV-2 infection. Methods: A review was conducted of updated literature contained in bibliographic databases. A total 40 publications were consulted. An analysis was performed of the quality and reliability of the papers selected. Data analysis and integration: In the initial stage of the immune response to SARS-CoV-2 there is a predominance of innate defense mechanisms aimed at eliminating the virus and preventing the progress of the disease toward severity. If the immune system fails to eradicate the virus, immune dysregulation will occur and considerable damage will result from tissue inflammation. Immunotherapy should focus on stimulating the first (protective) stage and delete the second. An appropriate immune response is vital in the combat against coronavirus infections. Conclusions: The dynamics of the antiviral response in SARS-CoV-2 patients are essential elements conditioning the severity of the disease. Occurrence of the cytokine storm resulting from immune dysregulation has been cited as the primary cause of the severe respiratory syndrome developing in these patients. Better knowledge about the immunopathogenic mechanisms involved is indispensable to develop highly efficient drugs(AU)


Subject(s)
Humans , Antiviral Agents , Pharmaceutical Preparations , Coronavirus Infections , Defense Mechanisms , Cytokine Release Syndrome , Immune System
3.
Rev. méd. Minas Gerais ; 31: 31209, 2021.
Article in Portuguese | LILACS | ID: biblio-1292752

ABSTRACT

Introdução: O tratamento da leucemia linfoblástica aguda (LLA) atualmente baseia-se em quimioterapia e/ou transplante de células tronco hematopoiéticas; entretanto, uma nova terapia vem se tornando promissora: a imunoterapia com células T modificadas geneticamente que expressam um receptor de antígeno quimérico (CAR-T) visando antígenos específicos presente em blastos de LLA, gerando resultados promissores em crianças e adultos com doença recidivada e refratária (r/r). Objetivo: Discorrer sobre a LLA e descrever a imunoterapia com CAR-T, como inovação terapêutica no tratamento da LLA de linhagem B. Método: Foi realizada uma revisão bibliográfica por meio de publicações indexadas nas bases de dados Scielo e Pubmed, utilizando os descritores: leucemia linfoblástica aguda de células B; células CAR-T; receptores de antígeno quimérico, recidivados/refratários; imunoterapia. Resultados: As altas taxas de remissão completa (42% até 100%) e parcial (28,5%) da LLA (r/r) tratadas com CAR-T, possibilitam um aumento considerável da sobrevida geral comparado a outros tratamentos convencionais. Efeitos desfavoráveis, tais como síndrome da liberação de citocinas (CRS) (0 até 90%) e neurotoxicidade (NT) (0 até 29%) podem ser vistos, sendo manejáveis, não prejudicando o desfecho do tratamento. Conclusão: A LLA é uma doença grave, de difícil tratamento e prognóstico reservado. A imunoterapia vêm se mostrando promissora à essa enfermidade, principalmente em casos de doença r/r se mostrado uma ferramenta poderosa que permite o foco específico de células malignas por meio de engenharia de células T


Introduction: The treatment of acute lymphoblastic leukemia (ALL) is currently based on chemotherapy and/or hematopoietic stem cell transplantation; however, a new therapy is becoming promising: immunotherapy with genetically modified T cells that express a chimeric antigen receptor (CAR-T) targeting specific antigens present on ALL blasts, reaching promising results in children and adults with relapsed and refractory disease (r/r). Objective: To discuss ALL and describe immunotherapy with CAR-T as a therapeutic innovation in the treatment of B-lineage ALL. Method: A literature review was carried out through publications indexed in the Scielo and Pubmed databases, using the following descriptors: B-cell acute lymphoblastic leukemia; CAR-T cells; chimeric antigen receptors, relapsed/refractory; immunotherapy. Results: The high rates of complete (42% to 100%) and partial remission (28.5%) of ALL (r/r) treated with CAR-T allows a considerable increase in overall survival compared to other conventional treatments. Unfavorable effects such as cytokine release syndrome (CRS) (0 to 90%) and neurotoxicity (NT) (0 to 29%) can be seen, being manageable, not impairing the treatment outcome. Conclusion: ALL is a serious disease, with a difficult treatment and poor prognosis. Immunotherapy has shown benefits for this disease, especially in cases of r/r ALL, showing itself to be a powerful tool that allows the specific focus of malignant cells through T cell engineering.


Subject(s)
Humans , Child , Adult , Leukemia/therapy , Receptors, Chimeric Antigen , Immunotherapy , Neprilysin , Immunotherapy, Adoptive , Hematopoietic Stem Cell Transplantation , Cytokine Release Syndrome
4.
Rev. cuba. med. mil ; 49(4): e926, tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1156494

ABSTRACT

Introducción: El CIGB-258 es un péptido inmunomodulador con propiedades antiinflamatorias. Objetivos: Establecer la frecuencia de dosis y el tiempo de tratamiento con el péptido CIGB-258, para pacientes críticos con COVID-19. Además, definir los criterios de uso y el esquema terapéutico del péptido, para pacientes graves con COVID-19. Métodos: Se incluyeron 9 pacientes críticos y 3 pacientes graves. Las evaluaciones clínicas, radiológicas y de laboratorio se registraron de acuerdo al protocolo establecido. Se obtuvieron muestras de suero antes y después del tratamiento con la CIGB-258, para la determinación de los biomarcadores de la inflamación. Resultados: Se estableció el protocolo de actuación con el péptido CIGB-258, el cual consiste en la administración intravenosa de 1 mg del péptido cada 12 horas a los pacientes críticos. La dosis debe aumentarse a 2 mg cada 12 horas, para los pacientes que no muestren mejoría clínica y radiológica en 24 horas. Después de la extubación, los pacientes deben recibir 1 mg de CIGB-258 al día, durante otros tres días. Los pacientes graves deben recibir 1 mg de CIGB-258 cada 12 horas, hasta que resuelvan su condición clínica. Conclusiones: CIGB-258 mostró un buen perfil de seguridad. El protocolo de actuación establecido contribuyó a que todos los pacientes críticos se recuperaran de la dificultad respiratoria y fueran extubados. Los pacientes graves mejoraron considerablemente. Los niveles de los biomarcadores asociados con hiperinflamación y las citocinas disminuyeron significativamente durante el tratamiento(AU)


Introduction: CIGB-258 is an immunomodulatory peptide with anti-inflammatory properties. Objectives: To establish the therapeutic schedule with CIGB-258 peptide for COVID-19 critically ill patients. In addition, to define the criteria for use and schedule of this peptide for COVID-19 seriously ill patients. Methods: 9 critically ill patients and 3 seriously ill patients were included in this study. Clinical, radiological and laboratory evaluations were recorded according to the established protocol. Serum samples were obtained before and after treatment with CIGB-258, for the determination of the inflammation biomarkers. Results: The therapeutic protocol was established with the CIGB-258 peptide, which consists of intravenous administration of 1 mg of peptide every 12 hours for critically ill patients. The dose should be increased to 2 mg every 12 hours, for patients who do not show clinical and radiological improvement in 24 hours. After extubation, patients should receive 1 mg of CIGB-258 daily, for another three days. Seriously ill patients should receive 1 mg of CIGB-258 every 12 hours, until their clinical condition resolves. Conclusions: CIGB-258 showed an excellent safety profile. The established therapeutic protocol contributed to all critically ill patients recovering from respiratory distress and being extubated. Seriously ill patients improved considerably. The levels of the biomarkers associated with hyperinflammation and cytokines decreased significantly during treatment(AU)


Subject(s)
Humans , Critical Illness/therapy , Chaperonin 60 , Reference Drugs , Cytokine Release Syndrome/epidemiology , COVID-19/drug therapy
5.
Protein & Cell ; (12): 723-739, 2020.
Article in English | WPRIM | ID: wpr-828747

ABSTRACT

Emerging and re-emerging RNA viruses occasionally cause epidemics and pandemics worldwide, such as the on-going outbreak of the novel coronavirus SARS-CoV-2. Herein, we identified two potent inhibitors of human DHODH, S312 and S416, with favorable drug-likeness and pharmacokinetic profiles, which all showed broad-spectrum antiviral effects against various RNA viruses, including influenza A virus, Zika virus, Ebola virus, and particularly against SARS-CoV-2. Notably, S416 is reported to be the most potent inhibitor so far with an EC of 17 nmol/L and an SI value of 10,505.88 in infected cells. Our results are the first to validate that DHODH is an attractive host target through high antiviral efficacy in vivo and low virus replication in DHODH knock-out cells. This work demonstrates that both S312/S416 and old drugs (Leflunomide/Teriflunomide) with dual actions of antiviral and immuno-regulation may have clinical potentials to cure SARS-CoV-2 or other RNA viruses circulating worldwide, no matter such viruses are mutated or not.


Subject(s)
Animals , Antiviral Agents , Pharmacology , Therapeutic Uses , Betacoronavirus , Physiology , Binding Sites , Cell Line , Coronavirus Infections , Drug Therapy , Virology , Crotonates , Pharmacology , Cytokine Release Syndrome , Drug Therapy , Drug Evaluation, Preclinical , Gene Knockout Techniques , Humans , Influenza A virus , Leflunomide , Pharmacology , Mice , Mice, Inbred BALB C , Orthomyxoviridae Infections , Drug Therapy , Oseltamivir , Therapeutic Uses , Oxidoreductases , Metabolism , Pandemics , Pneumonia, Viral , Drug Therapy , Virology , Protein Binding , Pyrimidines , RNA Viruses , Physiology , Structure-Activity Relationship , Toluidines , Pharmacology , Ubiquinone , Metabolism , Virus Replication
6.
Protein & Cell ; (12): 740-770, 2020.
Article in English | WPRIM | ID: wpr-828746

ABSTRACT

Age-associated changes in immune cells have been linked to an increased risk for infection. However, a global and detailed characterization of the changes that human circulating immune cells undergo with age is lacking. Here, we combined scRNA-seq, mass cytometry and scATAC-seq to compare immune cell types in peripheral blood collected from young and old subjects and patients with COVID-19. We found that the immune cell landscape was reprogrammed with age and was characterized by T cell polarization from naive and memory cells to effector, cytotoxic, exhausted and regulatory cells, along with increased late natural killer cells, age-associated B cells, inflammatory monocytes and age-associated dendritic cells. In addition, the expression of genes, which were implicated in coronavirus susceptibility, was upregulated in a cell subtype-specific manner with age. Notably, COVID-19 promoted age-induced immune cell polarization and gene expression related to inflammation and cellular senescence. Therefore, these findings suggest that a dysregulated immune system and increased gene expression associated with SARS-CoV-2 susceptibility may at least partially account for COVID-19 vulnerability in the elderly.


Subject(s)
Adult , Aged , Aged, 80 and over , Aging , Genetics , Allergy and Immunology , Betacoronavirus , CD4-Positive T-Lymphocytes , Metabolism , Cell Lineage , Chromatin Assembly and Disassembly , Coronavirus Infections , Allergy and Immunology , Cytokine Release Syndrome , Allergy and Immunology , Cytokines , Genetics , Disease Susceptibility , Flow Cytometry , Methods , Gene Expression Profiling , Gene Expression Regulation, Developmental , Gene Rearrangement , Humans , Immune System , Cell Biology , Allergy and Immunology , Immunocompetence , Genetics , Inflammation , Genetics , Allergy and Immunology , Mass Spectrometry , Methods , Middle Aged , Pandemics , Pneumonia, Viral , Allergy and Immunology , Sequence Analysis, RNA , Single-Cell Analysis , Transcriptome , Young Adult
7.
Protein & Cell ; (12): 723-739, 2020.
Article in English | WPRIM | ID: wpr-828583

ABSTRACT

Emerging and re-emerging RNA viruses occasionally cause epidemics and pandemics worldwide, such as the on-going outbreak of the novel coronavirus SARS-CoV-2. Herein, we identified two potent inhibitors of human DHODH, S312 and S416, with favorable drug-likeness and pharmacokinetic profiles, which all showed broad-spectrum antiviral effects against various RNA viruses, including influenza A virus, Zika virus, Ebola virus, and particularly against SARS-CoV-2. Notably, S416 is reported to be the most potent inhibitor so far with an EC of 17 nmol/L and an SI value of 10,505.88 in infected cells. Our results are the first to validate that DHODH is an attractive host target through high antiviral efficacy in vivo and low virus replication in DHODH knock-out cells. This work demonstrates that both S312/S416 and old drugs (Leflunomide/Teriflunomide) with dual actions of antiviral and immuno-regulation may have clinical potentials to cure SARS-CoV-2 or other RNA viruses circulating worldwide, no matter such viruses are mutated or not.


Subject(s)
Animals , Antiviral Agents , Pharmacology , Therapeutic Uses , Betacoronavirus , Physiology , Binding Sites , Cell Line , Coronavirus Infections , Drug Therapy , Virology , Crotonates , Pharmacology , Cytokine Release Syndrome , Drug Therapy , Drug Evaluation, Preclinical , Gene Knockout Techniques , Humans , Influenza A virus , Leflunomide , Pharmacology , Mice , Mice, Inbred BALB C , Orthomyxoviridae Infections , Drug Therapy , Oseltamivir , Therapeutic Uses , Oxidoreductases , Metabolism , Pandemics , Pneumonia, Viral , Drug Therapy , Virology , Protein Binding , Pyrimidines , RNA Viruses , Physiology , Structure-Activity Relationship , Toluidines , Pharmacology , Ubiquinone , Metabolism , Virus Replication
8.
Protein & Cell ; (12): 740-770, 2020.
Article in English | WPRIM | ID: wpr-828582

ABSTRACT

Age-associated changes in immune cells have been linked to an increased risk for infection. However, a global and detailed characterization of the changes that human circulating immune cells undergo with age is lacking. Here, we combined scRNA-seq, mass cytometry and scATAC-seq to compare immune cell types in peripheral blood collected from young and old subjects and patients with COVID-19. We found that the immune cell landscape was reprogrammed with age and was characterized by T cell polarization from naive and memory cells to effector, cytotoxic, exhausted and regulatory cells, along with increased late natural killer cells, age-associated B cells, inflammatory monocytes and age-associated dendritic cells. In addition, the expression of genes, which were implicated in coronavirus susceptibility, was upregulated in a cell subtype-specific manner with age. Notably, COVID-19 promoted age-induced immune cell polarization and gene expression related to inflammation and cellular senescence. Therefore, these findings suggest that a dysregulated immune system and increased gene expression associated with SARS-CoV-2 susceptibility may at least partially account for COVID-19 vulnerability in the elderly.


Subject(s)
Adult , Aged , Aged, 80 and over , Aging , Genetics , Allergy and Immunology , Betacoronavirus , CD4-Positive T-Lymphocytes , Metabolism , Cell Lineage , Chromatin Assembly and Disassembly , Coronavirus Infections , Allergy and Immunology , Cytokine Release Syndrome , Allergy and Immunology , Cytokines , Genetics , Disease Susceptibility , Flow Cytometry , Methods , Gene Expression Profiling , Gene Expression Regulation, Developmental , Gene Rearrangement , Humans , Immune System , Cell Biology , Allergy and Immunology , Immunocompetence , Genetics , Inflammation , Genetics , Allergy and Immunology , Mass Spectrometry , Methods , Middle Aged , Pandemics , Pneumonia, Viral , Allergy and Immunology , Sequence Analysis, RNA , Single-Cell Analysis , Transcriptome , Young Adult
9.
Article in Chinese | WPRIM | ID: wpr-828548

ABSTRACT

OBJECTIVE@#To observe the clinical effect of plasma exchange and tocilizumab in treatment of patients with severe coronavirus disease 2019 (COVID-19).@*METHODS@#Six patients with severe COVID-19 admitted in First Affiliated Hospital of Bengbu Medical College from January 25 to February 25, 2020. Three patients were treated with plasma exchange and three patients were treated with tocilizumab. The effect on excessive inflammatory reaction of plasma exchange and tocilizumab was observed.@*RESULTS@#The C-reactive protein (CRP) and IL-6 levels were significantly decreased and the lymphocyte and prothrombin time were improved in 3 patients after treatment with plasma exchange; while inflammation level was not significantly decreased, and lymphocyte and prothrombin time did not improve in 3 patients treated with tocilizumab.@*CONCLUSIONS@#For severe COVID-19 patients with strong inflammatory reaction, plasma exchange may be preferred.


Subject(s)
Antibodies, Monoclonal, Humanized , Betacoronavirus , Coronavirus Infections , Blood , Allergy and Immunology , Therapeutics , Cytokine Release Syndrome , Therapeutics , Humans , Pandemics , Plasma Exchange , Reference Standards , Pneumonia, Viral , Blood , Allergy and Immunology , Therapeutics , Prothrombin Time , Treatment Outcome
10.
Protein & Cell ; (12): 723-739, 2020.
Article in English | WPRIM | ID: wpr-827018

ABSTRACT

Emerging and re-emerging RNA viruses occasionally cause epidemics and pandemics worldwide, such as the on-going outbreak of the novel coronavirus SARS-CoV-2. Herein, we identified two potent inhibitors of human DHODH, S312 and S416, with favorable drug-likeness and pharmacokinetic profiles, which all showed broad-spectrum antiviral effects against various RNA viruses, including influenza A virus, Zika virus, Ebola virus, and particularly against SARS-CoV-2. Notably, S416 is reported to be the most potent inhibitor so far with an EC of 17 nmol/L and an SI value of 10,505.88 in infected cells. Our results are the first to validate that DHODH is an attractive host target through high antiviral efficacy in vivo and low virus replication in DHODH knock-out cells. This work demonstrates that both S312/S416 and old drugs (Leflunomide/Teriflunomide) with dual actions of antiviral and immuno-regulation may have clinical potentials to cure SARS-CoV-2 or other RNA viruses circulating worldwide, no matter such viruses are mutated or not.


Subject(s)
Animals , Antiviral Agents , Pharmacology , Therapeutic Uses , Betacoronavirus , Physiology , Binding Sites , Cell Line , Coronavirus Infections , Drug Therapy , Virology , Crotonates , Pharmacology , Cytokine Release Syndrome , Drug Therapy , Drug Evaluation, Preclinical , Gene Knockout Techniques , Humans , Influenza A virus , Leflunomide , Pharmacology , Mice , Mice, Inbred BALB C , Orthomyxoviridae Infections , Drug Therapy , Oseltamivir , Therapeutic Uses , Oxidoreductases , Metabolism , Pandemics , Pneumonia, Viral , Drug Therapy , Virology , Protein Binding , Pyrimidines , RNA Viruses , Physiology , Structure-Activity Relationship , Toluidines , Pharmacology , Ubiquinone , Metabolism , Virus Replication
11.
Protein & Cell ; (12): 740-770, 2020.
Article in English | WPRIM | ID: wpr-827016

ABSTRACT

Age-associated changes in immune cells have been linked to an increased risk for infection. However, a global and detailed characterization of the changes that human circulating immune cells undergo with age is lacking. Here, we combined scRNA-seq, mass cytometry and scATAC-seq to compare immune cell types in peripheral blood collected from young and old subjects and patients with COVID-19. We found that the immune cell landscape was reprogrammed with age and was characterized by T cell polarization from naive and memory cells to effector, cytotoxic, exhausted and regulatory cells, along with increased late natural killer cells, age-associated B cells, inflammatory monocytes and age-associated dendritic cells. In addition, the expression of genes, which were implicated in coronavirus susceptibility, was upregulated in a cell subtype-specific manner with age. Notably, COVID-19 promoted age-induced immune cell polarization and gene expression related to inflammation and cellular senescence. Therefore, these findings suggest that a dysregulated immune system and increased gene expression associated with SARS-CoV-2 susceptibility may at least partially account for COVID-19 vulnerability in the elderly.


Subject(s)
Adult , Aged , Aged, 80 and over , Aging , Genetics , Allergy and Immunology , Betacoronavirus , CD4-Positive T-Lymphocytes , Metabolism , Cell Lineage , Chromatin Assembly and Disassembly , Coronavirus Infections , Allergy and Immunology , Cytokine Release Syndrome , Allergy and Immunology , Cytokines , Genetics , Disease Susceptibility , Flow Cytometry , Methods , Gene Expression Profiling , Gene Expression Regulation, Developmental , Gene Rearrangement , Humans , Immune System , Cell Biology , Allergy and Immunology , Immunocompetence , Genetics , Inflammation , Genetics , Allergy and Immunology , Mass Spectrometry , Methods , Middle Aged , Pandemics , Pneumonia, Viral , Allergy and Immunology , Sequence Analysis, RNA , Single-Cell Analysis , Transcriptome , Young Adult
12.
Medwave ; 20(7): e7998, 2020.
Article in English, Spanish | LILACS | ID: biblio-1122648

ABSTRACT

El síndrome respiratorio agudo grave coronavirus 2 (SARS-CoV-2) se ha diseminado rápidamente a lo largo del mundo causando una mortalidad significativa en pacientes de alto riesgo con manifestaciones severas. A la fecha, Remdesivir ha sido el único antiviral autorizado por la FDA para uso de emergencia. Una de las posibles complicaciones de esta infección es el desarrollo de tormenta de citoquinas, para la cual no existe un tratamiento óptimo. Presentamos el caso de un varón de 48 años sin antecedentes médicos que acudió al hospital con disnea, tos, fiebre subjetiva y diarrea durante 10 días. La reacción de cadena polimerasa nasofaríngea fue positiva para SARS-CoV-2. Su estado respiratorio empeoró rápidamente hasta el punto de requerir oxígeno suplementario a través cánula nasal de alto flujo con 80% de FiO2. La tomografía computarizada de tórax mostró opacidades confluyentes en vidrio esmerilado en los lóbulos superiores, acompañadas de opacidades irregulares alveolares en los lóbulos inferiores bilateralmente. Se inició terapia con hidroxicloroquina, la cual se cambió a Remdesivir cuando estuvo disponible. Luego se inició metilprednisolona como tratamiento de una posible tormenta de citoquinas. La oxigenación del paciente mejoró significativamente en los días posteriores y fue dado de alta sin requerir oxigeno adicional y saturando 96% en medio ambiente. Nuestro caso ilustra el papel de Remdesivir en el tratamiento de la neumonía grave por COVID-19. También observamos un posible beneficio clínico de los corticoides en tormenta de citoquinas. Se necesitan más estudios para evaluar la eficacia de esta estrategia terapéutica.


Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread throughout the world causing significant mortality in high risk patients with severe manifestations. To date, Remdesivir has been the only antiviral authorized by FDA as therapy for emergency use. One of the potential complications of this infection is cytokine storm, which optimal treatment remains unknown. We present the case of a 48-year-old man with no past medical history who presented to the hospital with dyspnea, cough, subjective fever, and diarrhea for 10 days. Nasopharyngeal PCR was positive for SARS-CoV-2. His respiratory status rapidly worsened to the point of requiring supplemental oxygen by high flow nasal cannula with FiO2 of 80%. Chest computed tomography showed confluent ground glass opacities in upper lobes accompanied by patchy airspace opacities in lower lobes bilaterally. He was started on hydroxychloroquine, which was switched to Remdesivir when it became available. Then, methylprednisolone was initiated for suspected cytokine storm. The patient's oxygenation improved significantly over the following days and he was discharged home with no oxygen supplementation and saturating 96% on room air. Our case illustrates the role of Remdesivir for the treatment of severe COVID-19 pneumonia. We also observed a possible clinical benefit of corticosteroids in the context of suspected cytokine storm. Further studies are needed to evaluate this therapeutic strategy.


Subject(s)
Humans , Male , Middle Aged , Antiviral Agents/therapeutic use , Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , COVID-19/drug therapy , Methylprednisolone/therapeutic use , Adenosine Monophosphate/therapeutic use , Alanine/therapeutic use , Pandemics , Cytokine Release Syndrome/etiology , Cytokine Release Syndrome/drug therapy , COVID-19/complications , COVID-19/diagnosis , Glucocorticoids/therapeutic use
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