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[Fatal course of COVID-19 despite IL-6 receptor blockade in cytokine storm : Perimyocarditis and coagulopathy after administration of tocilizumab]. / Fataler COVID-19-Verlauf trotz IL­6­Rezeptor-Blockade im Zytokinsturm : Perimyokarditis und Koagulopathie nach Tocilizumabgabe.
Bovet, M; Wadsack, D; Kosely, F; Zink, W; Zahn, R.
  • Bovet M; Klinik für Kardiologie, Pneumologie, Angiologie und Internistische Intensivmedizin (Medizinische Klinik B), Klinikum Ludwigshafen, Bremserstraße 79, 67073, Ludwigshafen, Deutschland. bovetm@klilu.de.
  • Wadsack D; Klinik für Innere Medizin, Hämato-Onkologie, Nephrologie, Infektiologie und Rheumatologie (Medizinische Klinik A), Klinikum Ludwigshafen, Ludwigshafen, Deutschland.
  • Kosely F; Klinik für Kardiologie, Pneumologie, Angiologie und Internistische Intensivmedizin (Medizinische Klinik B), Klinikum Ludwigshafen, Bremserstraße 79, 67073, Ludwigshafen, Deutschland.
  • Zink W; Klinik für Anästhesiologie, Operative Intensivmedizin und Notfallmedizin, Klinikum Ludwigshafen, Ludwigshafen, Deutschland.
  • Zahn R; Klinik für Kardiologie, Pneumologie, Angiologie und Internistische Intensivmedizin (Medizinische Klinik B), Klinikum Ludwigshafen, Bremserstraße 79, 67073, Ludwigshafen, Deutschland.
Anaesthesist ; 70(2): 121-126, 2021 Feb.
Article in German | MEDLINE | ID: covidwho-1453674
Semantic information from SemMedBD (by NLM)
1. COVID-19 COEXISTS_WITH Cytokine Storm
Subject
COVID-19
Predicate
COEXISTS_WITH
Object
Cytokine Storm
2. tocilizumab TREATS Cytokine Storm
Subject
tocilizumab
Predicate
TREATS
Object
Cytokine Storm
3. tocilizumab TREATS COVID-19
Subject
tocilizumab
Predicate
TREATS
Object
COVID-19
4. COVID-19 COEXISTS_WITH Cytokine Storm
Subject
COVID-19
Predicate
COEXISTS_WITH
Object
Cytokine Storm
5. tocilizumab TREATS Cytokine Storm
Subject
tocilizumab
Predicate
TREATS
Object
Cytokine Storm
6. tocilizumab TREATS COVID-19
Subject
tocilizumab
Predicate
TREATS
Object
COVID-19
ABSTRACT
A 59-year-old male patient was admitted to hospital diagnosed with moderate pneumonia associated with COVID-19. Upfront treatment with hydroxychloroquine and azithromycin was started. Due to a clinical deterioration (ARDS, circulatory shock) and greatly increased inflammation markers 6 days after admission, a cytokine storm was suspected and off-label treatment with the IL­6 receptor antagonist tocilizumab was initiated. Subsequently there was a dramatic rise of D­dimers indicating pulmonary intravascular coagulopathy and respiratory insufficiency worsened. After a second dose of tocilizumab was administered severe perimyocarditis with cardiac arrhythmia, hemodynamic instability and ST elevation occurred. Shortly afterwards the patient died due to multiorgan failure. From our experience, exacerbation of COVID-19 following treatment with tocilizumab cannot be ruled out. Randomized controlled studies are necessary to further investigate the efficacy, safety and patient selection criteria for tocilizumab treatment in COVID-19.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Antiviral Agents / Blood Coagulation Disorders / Receptors, Interleukin-6 / Antibodies, Monoclonal, Humanized / Cytokine Release Syndrome / COVID-19 / Myocarditis Subject: Antiviral Agents / Blood Coagulation Disorders / Receptors, Interleukin-6 / Antibodies, Monoclonal, Humanized / Cytokine Release Syndrome / COVID-19 / Myocarditis Type of study: Case report Language: German Journal: Anaesthesist Clinical aspect: Etiology / Prognosis / Therapy Year: 2021

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Antiviral Agents / Blood Coagulation Disorders / Receptors, Interleukin-6 / Antibodies, Monoclonal, Humanized / Cytokine Release Syndrome / COVID-19 / Myocarditis Subject: Antiviral Agents / Blood Coagulation Disorders / Receptors, Interleukin-6 / Antibodies, Monoclonal, Humanized / Cytokine Release Syndrome / COVID-19 / Myocarditis Type of study: Case report Language: German Journal: Anaesthesist Clinical aspect: Etiology / Prognosis / Therapy Year: 2021
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