Case Study: A Patient with Asthma, Covid-19 Pneumonia and Cytokine Release Syndrome Treated with Corticosteroids and Tocilizumab

Abstract

Severe acute respiratory syndrome coronavirus-2 (SARSCoV-2) is the novel coronavirus first detected in Wuhan, China, that causes coronavirus disease 2019 (Covid-19) and pneumonia. Covid-19 pneumonia is defined by a positive result for SARS-CoV-2 on a reverse-transcriptase– polymerase-chain-reaction (RT-PCR) assay of a specimen collected from the upper or lower respiratory tract together with radiological features of pneumonia and clinical features of hypoxaemia and dyspnoea. Although more than 80% of patients with Covid-19 infection have mild disease and make a full recovery, a significant proportion of patients progress to pneumonia, and about half of these cases will develop severe acute respiratory syndrome (ARDS). Initial reports from China suggested that age >65 years and medical comorbidities are risk factors for poor outcomes.(1) The need for ICU admission and mechanical ventilation once ARDS develops is associated with a high mortality, ranging from 39% to 72%.(2,3) Current guidelines recommend that corticosteroids or immunosuppressive therapy should not be used in patients with Covid-19 pneumonia unless there are other indications, such as shock, asthma or exacerbation of chronic obstructive pulmonary disease.(4) However, the role of systemic corticosteroids is currently being re-evaluated in mechanically ventilated adults with ARDS, with some guidelines now suggesting their use.(5) We describe a case of a patient with Covid-19 infection, progressive pneumonia, development of a hyperinflammatory state and cytokine release syndrome (CRS) who was successfully treated with steroids and tocilizumab. CASE REPORT