Case report
Post-transplant patients with COVID-19 associated acute respiratory distress syndrome, a role for Tociluzumab: A case series

https://doi.org/10.1016/j.rmcr.2020.101319Get rights and content
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Abstract

COVID-19 is the disease caused by SARS-CoV-2 that portends both a relatively high mortality rate as well as high rate of intensive care admission amongst all age groups; however effective therapy remains poorly characterized. Post-transplant patients are especially high risk and underrepresented in the literature. In these patients, cytokine release may play a significant role in the development of acute respiratory distress syndrome, raising the hypothesis that interleukin-6 inhibitors such as tocilizumab may be of benefit. Here, we describe two high-risk post-transplant patients who were treated with single-dose tocilizumab after intubation for moderate acute respiratory distress syndrome secondary to confirmed COVID-19 infection. Both patients recovered rapidly and were successfully extubated and discharged from the hospital without need for supplemental oxygen shortly thereafter, and their clinical improvement correlated with response in interleukin-6 levels. Tocilizumab appears to hold promise for critically ill COVID-19 patients who require mechanical ventilation when given shortly after intubation.

Keywords

COVID-19
Acute respiratory distress syndrome
Tocilizumab
Respiratory failure
Critical care

Abbreviations

LIST
ARDS
acute respiratory distress syndrome
COVID-19
coronavirus disease of 2019
CT
computerized tomography
IL
interleukin
CAR-T cell: chimeric antigen receptor T-cell

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