COVID-19 the Use of Tocilizumab: A Case Report

Abstract

Introduction: Coronavirus disease 2019 (COVID-19) is a modern and rapidly growing pandemic due to a novel coronavirus, SARS-CoV-2. The severity of this new virus strongly correlates with patients with advanced age or with underlying medical conditions. Those with advanced or severe symptoms from this virus are currently being treated with a trial of tocilizumab, an inhibitor of inflammatory responses including the cytokine Interleukin-6 (IL-6). As of current research there is no published clinical data supporting the use of this medication as treatment for this virus but have been discussed in anecdotal reports illustrating positive outcomes in COVID-19 infected patients.
Case Presentation: A 28-year-old obese and diabetic female presents to the emergency department with symptoms of shortness of breath, chills, and cough after being medically treated at a local urgent care facility one week prior. She endorsed worsening respiratory symptoms, fevers, and diaphoresis at the time and was eventually intubated and admitted to the ICU due to respiratory failure and having a strong clinical suspicion for COVID-19. Nasopharyngeal swab for SARS-CoV-2 was positive. The patient rapidly deteriorated despite treatment with hydroxychloroquine and underwent septic shock. Due to refractory treatment, the patient was administered a trial of tocilizumab and the patient had a remarkable clinical improvement over the next 12 hours, ultimately resulting in extubation. A combined regimen of tocilizumab, broad spectrum antibiotics, and a second course of hydroxychloroquine allowed the patient to make a full recovery.
Discussion: Given the novelty of SARS-CoV-2, evidence-based therapeutic strategies have not yet been developed. At this time, there are no medications approved by the US Food and Drug Administration (FDA) to treat COVID-19, per the Centers for Disease Control and Prevention (CDC). Supportive care measures include supplemental oxygen and mechanical ventilatory support when indicated. There are however several investigational COVID-19 treatment agents being evaluated and numerous clinical trials underway. Of the investigational agents being evaluated, hydroxychloroquine with or without azithromycin and IL-6 pathway inhibitors, such as tocilizumab, are being heavily studied due to positive anecdotal evidence. Currently, no guidelines outlining the use of these investigational agents exist. Individual institutions are encouraged to develop protocols for off-label use of these agents.