[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.
Anaesthesist
; 70(2): 121-126, 2021 Feb.
Article
in German
| MEDLINE | ID: covidwho-1453674
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.
Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Antiviral Agents
/
Blood Coagulation Disorders
/
Receptors, Interleukin-6
/
Antibodies, Monoclonal, Humanized
/
Cytokine Release Syndrome
/
COVID-19 Drug Treatment
/
Myocarditis
Type of study:
Case report
/
Experimental Studies
/
Prognostic study
/
Randomized controlled trials
Topics:
Vaccines
Limits:
Humans
/
Male
/
Middle aged
Language:
German
Journal:
Anaesthesist
Year:
2021
Document Type:
Article
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