Combined intravenous immunoglobulin and baricitinib treatment for severe COVID-19 with rhabdomyolysis: A case report.
Identifieur interne : 000122 ( Main/Corpus ); précédent : 000121; suivant : 000123Combined intravenous immunoglobulin and baricitinib treatment for severe COVID-19 with rhabdomyolysis: A case report.
Auteurs : Hao-Yu Wu ; Chien-Ting Pan ; Chiao-Feng Cheng ; Chi-Ying Lin ; Sheng-Nan Chang ; Yi-Chung Chen ; Chih-Yuan Wang ; Yen-Fu Chen ; Chung-Yu Chen ; Matthew Huei-Ming Ma ; Juey-Jen HwangSource :
- Journal of the Formosan Medical Association = Taiwan yi zhi [ 0929-6646 ] ; 2021.
Abstract
Since December 2019, the outbreak of coronavirus disease 2019 (COVID-19) has spread rapidly around the world. The severity of COVID-19 ranges from asymptomatic carriers to severe acute respiratory distress syndrome (ARDS). Accumulating evidence has shown that COVID-19 may be associated with multiple organ complications including cardiac injury, viral myositis and neurological deficits. Numerous laboratory biomarkers including lymphocytes, platelets, lactate dehydrogenase and creatine kinase (CK) have been associated with the prognostic outcomes of patients with COVID-19. However, dynamic correlations between levels of biomarkers and clinical course have not been studied. Herein, we report a 74-year-old female patient with severe COVID-19 which progressed to ARDS requiring intubation and mechanical ventilation. The laboratory findings showed lymphopenia, hypogammaglobulinemia, and elevated inflammatory biomarkers and CK. She received intensive therapy with hydroxychloroquine, lopinavir/ritonavir, and azithromycin with limited effects. Immunomodulatory treatments with high dose intravenous immunoglobulin and baricitinib were prescribed with satisfactory biochemical, radiographic and clinical recovery. We found an interesting correlation between serum CK elevation and inflammatory biomarkers, which reflected clinical improvement. This case demonstrates that inflammatory biomarkers, cytokines, and CK level correlated with disease severity and treatment response, and combined use of intravenous immunoglobulin and baricitinib is a potential treatment in patients with severe COVID-19.
DOI: 10.1016/j.jfma.2021.03.014
PubMed: 33838985
PubMed Central: PMC7988442
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Electronic address: pan.chienting.m@gmail.com.</nlm:affiliation></affiliation></author><author><name sortKey="Cheng, Chiao Feng" sort="Cheng, Chiao Feng" uniqKey="Cheng C" first="Chiao-Feng" last="Cheng">Chiao-Feng Cheng</name><affiliation><nlm:affiliation>Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.</nlm:affiliation></affiliation></author><author><name sortKey="Lin, Chi Ying" sort="Lin, Chi Ying" uniqKey="Lin C" first="Chi-Ying" last="Lin">Chi-Ying Lin</name><affiliation><nlm:affiliation>Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.</nlm:affiliation></affiliation></author><author><name sortKey="Chang, Sheng Nan" sort="Chang, Sheng Nan" uniqKey="Chang S" first="Sheng-Nan" last="Chang">Sheng-Nan Chang</name><affiliation><nlm:affiliation>Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.</nlm:affiliation></affiliation></author><author><name sortKey="Chen, Yi Chung" sort="Chen, Yi Chung" uniqKey="Chen Y" first="Yi-Chung" last="Chen">Yi-Chung Chen</name><affiliation><nlm:affiliation>Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.</nlm:affiliation></affiliation></author><author><name sortKey="Wang, Chih Yuan" sort="Wang, Chih Yuan" uniqKey="Wang C" first="Chih-Yuan" last="Wang">Chih-Yuan Wang</name><affiliation><nlm:affiliation>Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.</nlm:affiliation></affiliation></author><author><name sortKey="Chen, Yen Fu" sort="Chen, Yen Fu" uniqKey="Chen Y" first="Yen-Fu" last="Chen">Yen-Fu Chen</name><affiliation><nlm:affiliation>Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.</nlm:affiliation></affiliation></author><author><name sortKey="Chen, Chung Yu" sort="Chen, Chung Yu" uniqKey="Chen C" first="Chung-Yu" last="Chen">Chung-Yu Chen</name><affiliation><nlm:affiliation>Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.</nlm:affiliation></affiliation></author><author><name sortKey="Ma, Matthew Huei Ming" sort="Ma, Matthew Huei Ming" uniqKey="Ma M" first="Matthew Huei-Ming" last="Ma">Matthew Huei-Ming Ma</name><affiliation><nlm:affiliation>Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.</nlm:affiliation></affiliation></author><author><name sortKey="Hwang, Juey Jen" sort="Hwang, Juey Jen" uniqKey="Hwang J" first="Juey-Jen" last="Hwang">Juey-Jen Hwang</name><affiliation><nlm:affiliation>Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan. 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Electronic address: pan.chienting.m@gmail.com.</nlm:affiliation></affiliation></author><author><name sortKey="Cheng, Chiao Feng" sort="Cheng, Chiao Feng" uniqKey="Cheng C" first="Chiao-Feng" last="Cheng">Chiao-Feng Cheng</name><affiliation><nlm:affiliation>Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.</nlm:affiliation></affiliation></author><author><name sortKey="Lin, Chi Ying" sort="Lin, Chi Ying" uniqKey="Lin C" first="Chi-Ying" last="Lin">Chi-Ying Lin</name><affiliation><nlm:affiliation>Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.</nlm:affiliation></affiliation></author><author><name sortKey="Chang, Sheng Nan" sort="Chang, Sheng Nan" uniqKey="Chang S" first="Sheng-Nan" last="Chang">Sheng-Nan Chang</name><affiliation><nlm:affiliation>Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.</nlm:affiliation></affiliation></author><author><name sortKey="Chen, Yi Chung" sort="Chen, Yi Chung" uniqKey="Chen Y" first="Yi-Chung" last="Chen">Yi-Chung Chen</name><affiliation><nlm:affiliation>Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.</nlm:affiliation></affiliation></author><author><name sortKey="Wang, Chih Yuan" sort="Wang, Chih Yuan" uniqKey="Wang C" first="Chih-Yuan" last="Wang">Chih-Yuan Wang</name><affiliation><nlm:affiliation>Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.</nlm:affiliation></affiliation></author><author><name sortKey="Chen, Yen Fu" sort="Chen, Yen Fu" uniqKey="Chen Y" first="Yen-Fu" last="Chen">Yen-Fu Chen</name><affiliation><nlm:affiliation>Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.</nlm:affiliation></affiliation></author><author><name sortKey="Chen, Chung Yu" sort="Chen, Chung Yu" uniqKey="Chen C" first="Chung-Yu" last="Chen">Chung-Yu Chen</name><affiliation><nlm:affiliation>Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.</nlm:affiliation></affiliation></author><author><name sortKey="Ma, Matthew Huei Ming" sort="Ma, Matthew Huei Ming" uniqKey="Ma M" first="Matthew Huei-Ming" last="Ma">Matthew Huei-Ming Ma</name><affiliation><nlm:affiliation>Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.</nlm:affiliation></affiliation></author><author><name sortKey="Hwang, Juey Jen" sort="Hwang, Juey Jen" uniqKey="Hwang J" first="Juey-Jen" last="Hwang">Juey-Jen Hwang</name><affiliation><nlm:affiliation>Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan. Electronic address: jueyhwang@ntu.edu.tw.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Journal of the Formosan Medical Association = Taiwan yi zhi</title><idno type="ISSN">0929-6646</idno><imprint><date when="2021" type="published">2021</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Since December 2019, the outbreak of coronavirus disease 2019 (COVID-19) has spread rapidly around the world. The severity of COVID-19 ranges from asymptomatic carriers to severe acute respiratory distress syndrome (ARDS). Accumulating evidence has shown that COVID-19 may be associated with multiple organ complications including cardiac injury, viral myositis and neurological deficits. Numerous laboratory biomarkers including lymphocytes, platelets, lactate dehydrogenase and creatine kinase (CK) have been associated with the prognostic outcomes of patients with COVID-19. However, dynamic correlations between levels of biomarkers and clinical course have not been studied. Herein, we report a 74-year-old female patient with severe COVID-19 which progressed to ARDS requiring intubation and mechanical ventilation. The laboratory findings showed lymphopenia, hypogammaglobulinemia, and elevated inflammatory biomarkers and CK. She received intensive therapy with hydroxychloroquine, lopinavir/ritonavir, and azithromycin with limited effects. Immunomodulatory treatments with high dose intravenous immunoglobulin and baricitinib were prescribed with satisfactory biochemical, radiographic and clinical recovery. We found an interesting correlation between serum CK elevation and inflammatory biomarkers, which reflected clinical improvement. This case demonstrates that inflammatory biomarkers, cytokines, and CK level correlated with disease severity and treatment response, and combined use of intravenous immunoglobulin and baricitinib is a potential treatment in patients with severe COVID-19.</div></front></TEI><pubmed><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">33838985</PMID><DateRevised><Year>2021</Year><Month>04</Month><Day>15</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Print">0929-6646</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2021</Year><Month>Mar</Month><Day>24</Day></PubDate></JournalIssue><Title>Journal of the Formosan Medical Association = Taiwan yi zhi</Title><ISOAbbreviation>J Formos Med Assoc</ISOAbbreviation></Journal><ArticleTitle>Combined intravenous immunoglobulin and baricitinib treatment for severe COVID-19 with rhabdomyolysis: A case report.</ArticleTitle><ELocationID EIdType="pii" ValidYN="Y">S0929-6646(21)00119-4</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.jfma.2021.03.014</ELocationID><Abstract><AbstractText>Since December 2019, the outbreak of coronavirus disease 2019 (COVID-19) has spread rapidly around the world. The severity of COVID-19 ranges from asymptomatic carriers to severe acute respiratory distress syndrome (ARDS). Accumulating evidence has shown that COVID-19 may be associated with multiple organ complications including cardiac injury, viral myositis and neurological deficits. Numerous laboratory biomarkers including lymphocytes, platelets, lactate dehydrogenase and creatine kinase (CK) have been associated with the prognostic outcomes of patients with COVID-19. However, dynamic correlations between levels of biomarkers and clinical course have not been studied. Herein, we report a 74-year-old female patient with severe COVID-19 which progressed to ARDS requiring intubation and mechanical ventilation. The laboratory findings showed lymphopenia, hypogammaglobulinemia, and elevated inflammatory biomarkers and CK. She received intensive therapy with hydroxychloroquine, lopinavir/ritonavir, and azithromycin with limited effects. Immunomodulatory treatments with high dose intravenous immunoglobulin and baricitinib were prescribed with satisfactory biochemical, radiographic and clinical recovery. We found an interesting correlation between serum CK elevation and inflammatory biomarkers, which reflected clinical improvement. This case demonstrates that inflammatory biomarkers, cytokines, and CK level correlated with disease severity and treatment response, and combined use of intravenous immunoglobulin and baricitinib is a potential treatment in patients with severe COVID-19.</AbstractText><CopyrightInformation>Copyright © 2021 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Wu</LastName><ForeName>Hao-Yu</ForeName><Initials>HY</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pan</LastName><ForeName>Chien-Ting</ForeName><Initials>CT</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan. Electronic address: pan.chienting.m@gmail.com.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Cheng</LastName><ForeName>Chiao-Feng</ForeName><Initials>CF</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lin</LastName><ForeName>Chi-Ying</ForeName><Initials>CY</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chang</LastName><ForeName>Sheng-Nan</ForeName><Initials>SN</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chen</LastName><ForeName>Yi-Chung</ForeName><Initials>YC</Initials><AffiliationInfo><Affiliation>Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wang</LastName><ForeName>Chih-Yuan</ForeName><Initials>CY</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chen</LastName><ForeName>Yen-Fu</ForeName><Initials>YF</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chen</LastName><ForeName>Chung-Yu</ForeName><Initials>CY</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ma</LastName><ForeName>Matthew Huei-Ming</ForeName><Initials>MH</Initials><AffiliationInfo><Affiliation>Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hwang</LastName><ForeName>Juey-Jen</ForeName><Initials>JJ</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan. Electronic address: jueyhwang@ntu.edu.tw.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D002363">Case Reports</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2021</Year><Month>03</Month><Day>24</Day></ArticleDate></Article><MedlineJournalInfo><Country>Singapore</Country><MedlineTA>J Formos Med Assoc</MedlineTA><NlmUniqueID>9214933</NlmUniqueID><ISSNLinking>0929-6646</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">ARDS</Keyword><Keyword MajorTopicYN="N">Baricitinib</Keyword><Keyword MajorTopicYN="N">COVID-19</Keyword><Keyword MajorTopicYN="N">Creatine kinase</Keyword><Keyword MajorTopicYN="N">IVIg</Keyword></KeywordList><CoiStatement>Declaration of competing interest The authors have no conflicts of interest relevant to this article.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>05</Month><Day>23</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2021</Year><Month>03</Month><Day>15</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2021</Year><Month>03</Month><Day>16</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2021</Year><Month>4</Month><Day>11</Day><Hour>20</Hour><Minute>25</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2021</Year><Month>4</Month><Day>12</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2021</Year><Month>4</Month><Day>12</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>aheadofprint</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">33838985</ArticleId><ArticleId IdType="pii">S0929-6646(21)00119-4</ArticleId><ArticleId IdType="doi">10.1016/j.jfma.2021.03.014</ArticleId><ArticleId 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