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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
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.
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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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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