J Med Virol . Single dose of subcutaneous tocilizumab in Covid-pneumonia: CT evidence of lymphnodal and parenchymal response

[tetano]

J Med Virol


. 2020 Jul 27.
doi: 10.1002/jmv.26345. Online ahead of print.
Single dose of subcutaneous tocilizumab in Covid-pneumonia: CT evidence of lymphnodal and parenchymal response


A Vizzuso ¹ , S Piciucchi ¹ , D Tortola ² , C Grosso ³ , C Ravaglia ⁴ , V Poletti ^{4 5}



Affiliations

• PMID: 32716066
• DOI: 10.1002/jmv.26345

Abstract

A 60-years-old man, smoker, with bipolar disorder and history of hypertension, diabetes, and obesity, presented with a 5-days fever (38?C) and cough. His physical examination revealed exertional dyspnea and polypnea; saturation was 95% room air. He came from a protected nurse residence where some COVID positive subjects were already identified and his nasopharyngeal swab documented COVID infection positivity. CT scan showed patchy ground-glass nodules in the right upper lobe and a mild subpleural ground glass in the superior segment of left lower lobe. Numerous mediastinal and hilar lymphadenopathies, the biggest in 4R (short axis: 13mm), 7 (short axis: 14mm). The patient was treated with hydroxychloroquine, azithromycin and methylprednisolone. However, few days later he got worse in terms of gas exchange and laboratory tests (PaO2/FiO2 < 100; lymphocytes: 420/μl; IL-6: 56 pg/ml), so that he received a subcutaneous injection of tocilizumab and was intubated. After that, he showed a progressive improvement confirmed by CT scan with reduction in size of all the lymph nodes and complete disappearance of pulmonary infiltrates This article is protected by copyright. All rights reserved.

Keywords: Activation < Immune responses; Coronavirus < Virus classification; Immunomodulation < Immune responses.