Serveur d'exploration COVID et hydrochloroquine

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[Fatal course of COVID-19 despite IL-6 receptor blockade in cytokine storm : Perimyocarditis and coagulopathy after administration of tocilizumab].

Identifieur interne : 000026 ( Main/Exploration ); précédent : 000025; suivant : 000027

[Fatal course of COVID-19 despite IL-6 receptor blockade in cytokine storm : Perimyocarditis and coagulopathy after administration of tocilizumab].

Auteurs : M. Bovet [Allemagne] ; D. Wadsack [Allemagne] ; F. Kosely [Allemagne] ; W. Zink [Allemagne] ; R. Zahn [Allemagne]

Source :

RBID : pubmed:33064176

Descripteurs français

English descriptors

Abstract

A 59-year-old male patient was admitted to hospital diagnosed with moderate pneumonia associated with COVID-19. Upfront treatment with hydroxychloroquine and azithromycin was started. Due to a clinical deterioration (ARDS, circulatory shock) and greatly increased inflammation markers 6 days after admission, a cytokine storm was suspected and off-label treatment with the IL‑6 receptor antagonist tocilizumab was initiated. Subsequently there was a dramatic rise of D‑dimers indicating pulmonary intravascular coagulopathy and respiratory insufficiency worsened. After a second dose of tocilizumab was administered severe perimyocarditis with cardiac arrhythmia, hemodynamic instability and ST elevation occurred. Shortly afterwards the patient died due to multiorgan failure. From our experience, exacerbation of COVID-19 following treatment with tocilizumab cannot be ruled out. Randomized controlled studies are necessary to further investigate the efficacy, safety and patient selection criteria for tocilizumab treatment in COVID-19.

DOI: 10.1007/s00101-020-00871-x
PubMed: 33064176
PubMed Central: PMC7563901


Affiliations:


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Le document en format XML

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<div type="abstract" xml:lang="en">A 59-year-old male patient was admitted to hospital diagnosed with moderate pneumonia associated with COVID-19. Upfront treatment with hydroxychloroquine and azithromycin was started. Due to a clinical deterioration (ARDS, circulatory shock) and greatly increased inflammation markers 6 days after admission, a cytokine storm was suspected and off-label treatment with the IL‑6 receptor antagonist tocilizumab was initiated. Subsequently there was a dramatic rise of D‑dimers indicating pulmonary intravascular coagulopathy and respiratory insufficiency worsened. After a second dose of tocilizumab was administered severe perimyocarditis with cardiac arrhythmia, hemodynamic instability and ST elevation occurred. Shortly afterwards the patient died due to multiorgan failure. From our experience, exacerbation of COVID-19 following treatment with tocilizumab cannot be ruled out. Randomized controlled studies are necessary to further investigate the efficacy, safety and patient selection criteria for tocilizumab treatment in COVID-19.</div>
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<DescriptorName UI="D012128" MajorTopicYN="N">Respiratory Distress Syndrome</DescriptorName>
<QualifierName UI="Q000209" MajorTopicYN="N">etiology</QualifierName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D012131" MajorTopicYN="N">Respiratory Insufficiency</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName>
</MeshHeading>
</MeshHeadingList>
<OtherAbstract Type="Publisher" Language="ger">
<AbstractText Label="ZUSAMMENFASSUNG" NlmCategory="UNASSIGNED">Ein 59-jähriger Patient wurde wegen einer COVID-19-assoziierten Pneumonie stationär in einem Krankenhaus der Maximalversorgung mit Hydroxychloroquin und Azithromycin behandelt. Aufgrund einer klinischen Verschlechterung (ARDS, Kreislaufschock) sowie stark erhöhten Inflammationsmarkern 6 Tage nach Aufnahme wurde ein Zytokinsturm vermutet und daher der IL-6-Rezeptor-Blocker Tocilizumab verabreicht, woraufhin es zu einer Gerinnungsaktivierung und zunehmender respiratorischer Insuffizienz kam. Direkt nach Zweitgabe des Medikaments am Folgetag trat eine Perimyokarditis mit schweren Herzrhythmusstörungen auf. Der Patient verstarb kurz danach im Multiorganversagen. Eine Verschlechterung des Krankheitsbildes durch Tocilizumab ist unserer Erfahrung nach nicht auszuschließen.</AbstractText>
</OtherAbstract>
<KeywordList Owner="NOTNLM">
<Keyword MajorTopicYN="N">ARDS</Keyword>
<Keyword MajorTopicYN="N">Coagulopathy</Keyword>
<Keyword MajorTopicYN="N">ECMO</Keyword>
<Keyword MajorTopicYN="N">Perimyocarditis</Keyword>
<Keyword MajorTopicYN="N">Tocilizumab</Keyword>
</KeywordList>
</MedlineCitation>
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<History>
<PubMedPubDate PubStatus="received">
<Year>2020</Year>
<Month>04</Month>
<Day>22</Day>
</PubMedPubDate>
<PubMedPubDate PubStatus="accepted">
<Year>2020</Year>
<Month>09</Month>
<Day>21</Day>
</PubMedPubDate>
<PubMedPubDate PubStatus="revised">
<Year>2020</Year>
<Month>08</Month>
<Day>27</Day>
</PubMedPubDate>
<PubMedPubDate PubStatus="pubmed">
<Year>2020</Year>
<Month>10</Month>
<Day>17</Day>
<Hour>6</Hour>
<Minute>0</Minute>
</PubMedPubDate>
<PubMedPubDate PubStatus="medline">
<Year>2021</Year>
<Month>2</Month>
<Day>12</Day>
<Hour>6</Hour>
<Minute>0</Minute>
</PubMedPubDate>
<PubMedPubDate PubStatus="entrez">
<Year>2020</Year>
<Month>10</Month>
<Day>16</Day>
<Hour>12</Hour>
<Minute>9</Minute>
</PubMedPubDate>
</History>
<PublicationStatus>ppublish</PublicationStatus>
<ArticleIdList>
<ArticleId IdType="pubmed">33064176</ArticleId>
<ArticleId IdType="doi">10.1007/s00101-020-00871-x</ArticleId>
<ArticleId IdType="pii">10.1007/s00101-020-00871-x</ArticleId>
<ArticleId IdType="pmc">PMC7563901</ArticleId>
</ArticleIdList>
<ReferenceList>
<Title>Literatur</Title>
<Reference>
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<ArticleId IdType="doi">10.1056/NEJMoa2015432</ArticleId>
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</pubmed>
<affiliations>
<list>
<country>
<li>Allemagne</li>
</country>
</list>
<tree>
<country name="Allemagne">
<noRegion>
<name sortKey="Bovet, M" sort="Bovet, M" uniqKey="Bovet M" first="M" last="Bovet">M. Bovet</name>
</noRegion>
<name sortKey="Kosely, F" sort="Kosely, F" uniqKey="Kosely F" first="F" last="Kosely">F. Kosely</name>
<name sortKey="Wadsack, D" sort="Wadsack, D" uniqKey="Wadsack D" first="D" last="Wadsack">D. Wadsack</name>
<name sortKey="Zahn, R" sort="Zahn, R" uniqKey="Zahn R" first="R" last="Zahn">R. Zahn</name>
<name sortKey="Zink, W" sort="Zink, W" uniqKey="Zink W" first="W" last="Zink">W. Zink</name>
</country>
</tree>
</affiliations>
</record>

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