Tocilizumab as a Treatment for ‘Cytokine Storm Syndrome’ in COVID-19: A Case Report

Authors

  • Ari Fahrial Syam Fellow of the American College of Physicians; Division of Gastroenterology, Dept. of Internal Medicine, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Ceva W Pitoyo Division of Respirology and Critical Care, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta
  • Suhendro Suhendro Division of Tropical Medicine and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta
  • Benny Zulkarnain Department of Radiology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta
  • Nuri D Indrasari Department of Clinical Pathology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta
  • Dita Aditianingsih Department of Anesthesiology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta
  • Cosphiadi Irawan Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta
  • Adityo Susilo Division of Tropical Medicine and Infectious Disease, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta
  • Cleopas M Rumende Division of Respirology and Critical Care, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta
  • Ika P Wijaya Division of Cardiology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta
  • Fera Ibrahim Department of Micobiology Clinic, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta
  • Menaldi Rasmin Department of Pulmonology and Respiratory Medicine, Faculty of Medicine Universitas Indonesia - Persahabatan Hospital, Jakarta
  • Idrus Alwi Division of Cardiology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta
  • Dadang Makmun Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta

Keywords:

COVID-19, SARS-CoV-2, acute respiratory distress syndrome (ARDS), Tocilizumab

Abstract

Coronavirus disease 19 (COVID-19) which is caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), has been a problem worldwide, particularly due to the high rate of transmission and wide range of clinical manifestations. Acute respiratory distress syndrome (ARDS) and multiorgan failure are the most common events observed in severe cases and can be fatal. Cytokine storm syndrome emerges as one of the possibilities for the development of ARDS and multiorgan failure in severe cases of COVID-19. This case report describes a case of a 53-year-old male patient who has been diagnosed with COVID-19. Further evaluation in this patient showed that there was a marked increase in IL-6 level in blood accompanied with hyperferritinemia, which was in accordance with the characteristic of cytokine storm syndrome. Patient was treated with tocilizumab, a monoclonal antibody and is an antagonist to IL-6 receptor. The binding between tocilizumab and IL-6 receptors effectively inhibit and manage cytokine storm syndrome. Although this case report reported the efficacy of tocilizumab in managing cytokine storm syndrome, tocilizumab has several adverse effects requiring close monitoring. Further clinical randomized control trial is required to evaluate the efficacy and safety of tocilizumab administration in participants with various clinical characteristics and greater number of subjects. 

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Published

2021-07-11

How to Cite

Syam, A. F., Pitoyo, C. W., Suhendro, S., Zulkarnain, B., Indrasari, N. D., Aditianingsih, D., Irawan, C., Susilo, A., Rumende, C. M., Wijaya, I. P., Ibrahim, F., Rasmin, M., Alwi, I., & Makmun, D. (2021). Tocilizumab as a Treatment for ‘Cytokine Storm Syndrome’ in COVID-19: A Case Report. Acta Medica Indonesiana, 53(2), 194. Retrieved from https://actamedindones.org/index.php/ijim/article/view/1825

Issue

Vol. 53 No. 2 (2021): Acta Medica Indonesiana

Section

CASE REPORT

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