Clinical benefits of Tocilizumab in COVID-19-related cytokine release syndrome in a patient with end-stage kidney disease on haemodialysis in Australia

Nephrology (Carlton). 2020 Nov;25(11):845-849. doi: 10.1111/nep.13767. Epub 2020 Sep 17.

Abstract

COVID-19 remains a global pandemic with more than 10 million cases and half a million deaths worldwide. The disease manifestations in patients with chronic kidney disease and especially those on haemodialysis are still being understood, with only a few overseas case series, and small observational trials thus far. It appears that the disease is more severe in this patient cohort. Part of the pathophysiology of severe COVID-19 is related to accompanying cytokine release syndrome (CRS). Tocilizumab, an interleukin-6 inhibitor, has been trialled for treatment of CRS in COVID-19, but not yet approved. We present a case of an Australian patient on long-term haemodialysis with severe COVID-19 who was successfully treated with Tocilizumab. The peak of her illness was on day 7, with a C-reactive protein of 624 mg/L (reference < 5 mg/L), ferritin of 5293 ng/mL (reference 30-500 ng/mL), and interleukin-6 level 1959.7 pg/mL, consistent with CRS. She was severely hypoxic on a ventilator, with rising inotropic requirements. With the use of Tocilizumab, there was a significant and immediate response in her inflammatory markers, and she made a steady recovery. The patient was discharged home 6 weeks after presentation.

Keywords: chronic; coronavirus; cytokine release syndrome; dialysis; interleukin-6; kidney failure.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anemia* / etiology
  • Anemia* / therapy
  • Antibodies, Monoclonal, Humanized / administration & dosage*
  • Blood Transfusion / methods
  • C-Reactive Protein / analysis
  • COVID-19
  • Coronavirus Infections* / complications
  • Coronavirus Infections* / diagnosis
  • Coronavirus Infections* / immunology
  • Coronavirus Infections* / therapy
  • Cytokine Release Syndrome* / blood
  • Cytokine Release Syndrome* / therapy
  • Cytokine Release Syndrome* / virology
  • Female
  • Humans
  • Immunologic Factors / administration & dosage
  • Interleukin-6* / antagonists & inhibitors
  • Interleukin-6* / blood
  • Kidney Failure, Chronic* / complications
  • Kidney Failure, Chronic* / therapy
  • Monitoring, Immunologic / methods
  • Pandemics*
  • Pneumonia, Viral* / complications
  • Pneumonia, Viral* / diagnosis
  • Pneumonia, Viral* / immunology
  • Pneumonia, Viral* / therapy
  • Renal Dialysis / methods
  • Respiration, Artificial / methods
  • Treatment Outcome

Substances

  • Antibodies, Monoclonal, Humanized
  • Immunologic Factors
  • Interleukin-6
  • C-Reactive Protein
  • tocilizumab