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Case Reports
. 2020 Jul 17;4(FI1):1-6.
doi: 10.1093/ehjcr/ytaa188. eCollection 2020 Oct.

Successful treatment of acute heart failure in COVID-19-induced cytokine storm with tocilizumab: a case report

Kalyan R Chitturi  1 , Sameer Thacker  1 , Mukhtar A Al-Saadi  1 , Mahwash Kassi  2
Affiliations
Free PMC article
Case Reports

Successful treatment of acute heart failure in COVID-19-induced cytokine storm with tocilizumab: a case report

Kalyan R Chitturi et al. Eur Heart J Case Rep. .
Free PMC article

Abstract

Background: SARS-CoV-2 is known to induce a cytokine storm, a hyperinflammatory state driven by up-regulation of interleukin 6 (IL-6) and immunomodulatory chemokines that may result in acute heart failure.

Case summary: A 65-year-old woman with confirmed SARS-CoV-2 developed shock with multiorgan system failure, including acute biventricular heart failure, 2 weeks after the initial onset of fever, cough, and shortness of breath. The patient experienced myocardial recovery within 48 h after administration of tocilizumab, a humanized monoclonal anti-IL-6 receptor antibody, and multiple supportive vasoactive medications.

Discussion: The differential diagnosis of acute heart failure in critically ill patients with COVID-19 infection is broad, including sepsis-induced cardiomyopathy, Takotsubo syndrome, viral lymphocytic myocarditis, and acute coronary syndrome. Immunomodulatory treatment with tocilizumab may benefit patients who develop cardiogenic shock associated with SARS-CoV-2-induced cytokine storm.

Keywords: COVID-19; Case report; Cytokine; Heart failure; Myocarditis; Takotsubo; Tocilizumab.

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Figures

Figure 1
Figure 1
Non-contrast chest computed tomography scan demonstrating bilateral ground-glass opacities.
Figure 2
Figure 2
Electrocardiogram before and after new-onset acute decompensated heart failure. (A) Electrocardiogram before development of acute decompensated heart failure showing sinus rhythm with premature supraventricular complexes. (B) Electrocardiogram during cardiogenic shock showing sinus tachycardia with T-wave inversion in V1–V3 and a shift in the QRS axis compared with the earlier study.
Figure 3
Figure 3
Transthoracic echocardiography two-dimensional images during acute biventricular heart failure and 2 days after treatment with tocilizumab, dobutamine, norepinephrine, vasopressin, and inhaled epoprostenol. (A) Transthoracic echocardiography apical four-chamber view: severe global right ventricular and left ventricular hypokinesis with paradoxical septal motion and left ventricular ejection fraction of 25%. (B) Transthoracic echocardiography parasternal long-axis view 2 days after tocilizumab administration: complete recovery of left ventricular systolic function with ejection fraction of 64%, grade 2 diastolic dysfunction, and small circumferential pericardial effusion. (C) Transthoracic echocardiography apical four-chamber view 2 days after tocilizumab administration: mild right ventricular systolic dysfunction, much improved from the prior study.
Figure 4
Figure 4
Inflammatory markers at baseline and after administration of tocilizumab for COVID-19-induced cytokine storm.
None
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