CovidChloroV1, Main, Exploration, bibRecordById, pubmed:32562070

A complex COVID-19 case with rheumatoid arthritis treated with tocilizumab.

Identifieur interne : 001987 ( Main/Exploration ); précédent : 001986; suivant : 001988

A complex COVID-19 case with rheumatoid arthritis treated with tocilizumab.

Auteurs : Shaozhe Cai [République populaire de Chine] ; Wei Sun [République populaire de Chine] ; Ming Li [République populaire de Chine] ; Lingli Dong [République populaire de Chine]

Source :

Clinical rheumatology [ 1434-9949 ] ; 2020.

RBID : pubmed:32562070

Descripteurs français

English descriptors

KwdEn :
- Aged (MeSH), Anti-Bacterial Agents (therapeutic use), Antifungal Agents (therapeutic use), Antirheumatic Agents (therapeutic use), Antiviral Agents (therapeutic use), Arthritis, Rheumatoid (complications), Arthritis, Rheumatoid (drug therapy), Aspergillosis (MeSH), Aspergillus fumigatus (MeSH), Betacoronavirus (MeSH), COVID-19 (MeSH), Coronavirus Infections (complications), Coronavirus Infections (diagnostic imaging), Coronavirus Infections (physiopathology), Coronavirus Infections (therapy), Cough (etiology), Cytokine Release Syndrome (etiology), Deprescriptions (MeSH), Disease Progression (MeSH), Dyspnea (etiology), Female (MeSH), Glucocorticoids (adverse effects), Glucocorticoids (therapeutic use), Humans (MeSH), Hydroxychloroquine (therapeutic use), Immunocompromised Host (MeSH), Immunosuppressive Agents (adverse effects), Immunosuppressive Agents (therapeutic use), Interleukin-6 (blood), Leflunomide (adverse effects), Leflunomide (therapeutic use), Lung (diagnostic imaging), Lymphohistiocytosis, Hemophagocytic (diagnosis), Lymphohistiocytosis, Hemophagocytic (etiology), Lymphohistiocytosis, Hemophagocytic (immunology), Methylprednisolone (therapeutic use), Oxygen Inhalation Therapy (MeSH), Pandemics (MeSH), Pneumocystis carinii (MeSH), Pneumonia, Pneumocystis (diagnosis), Pneumonia, Pneumocystis (drug therapy), Pneumonia, Pneumocystis (etiology), Pneumonia, Pneumocystis (immunology), Pneumonia, Viral (complications), Pneumonia, Viral (diagnostic imaging), Pneumonia, Viral (physiopathology), Pneumonia, Viral (therapy), Pulmonary Aspergillosis (diagnosis), Pulmonary Aspergillosis (drug therapy), Pulmonary Aspergillosis (etiology), Pulmonary Aspergillosis (immunology), Recurrence (MeSH), SARS-CoV-2 (MeSH), Tomography, X-Ray Computed (MeSH).
MESH :
- chemical , adverse effects : Glucocorticoids, Immunosuppressive Agents, Leflunomide.
- chemical , blood : Interleukin-6.
- chemical , therapeutic use : Anti-Bacterial Agents, Antifungal Agents, Antirheumatic Agents, Antiviral Agents, Glucocorticoids, Hydroxychloroquine, Immunosuppressive Agents, Leflunomide, Methylprednisolone.
- complications : Arthritis, Rheumatoid, Coronavirus Infections, Pneumonia, Viral.
- diagnosis : Lymphohistiocytosis, Hemophagocytic, Pneumonia, Pneumocystis, Pulmonary Aspergillosis.
- diagnostic imaging : Coronavirus Infections, Lung, Pneumonia, Viral.
- drug therapy : Arthritis, Rheumatoid, Pneumonia, Pneumocystis, Pulmonary Aspergillosis.
- etiology : Cough, Cytokine Release Syndrome, Dyspnea, Lymphohistiocytosis, Hemophagocytic, Pneumonia, Pneumocystis, Pulmonary Aspergillosis.
- immunology : Lymphohistiocytosis, Hemophagocytic, Pneumonia, Pneumocystis, Pulmonary Aspergillosis.
- physiopathology : Coronavirus Infections, Pneumonia, Viral.
- therapy : Coronavirus Infections, Pneumonia, Viral.
- Aged, Aspergillosis, Aspergillus fumigatus, Betacoronavirus, COVID-19, Deprescriptions, Disease Progression, Female, Humans, Immunocompromised Host, Oxygen Inhalation Therapy, Pandemics, Pneumocystis carinii, Recurrence, SARS-CoV-2, Tomography, X-Ray Computed.

Abstract

Recurrences of COVID-19 were observed in a patient with long-term usage of hydroxychloroquine, leflunomide, and glucocorticoids due to her 30-year history of rheumatoid arthritis (RA). Tocilizumab was applied and intended to target both COVID-19 and RA. However, disease of this patient aggravated after usage of tocilizumab. After the discussion of a multiple disciplinary team (MDT) including rheumatologists, antimicrobial treatments were applied to target the potential opportunistic infections (Pneumocystis jirovecii and Aspergillus fumigatus), which were authenticated several days later via high throughput sequencing. As an important cytokine in immune responses, IL-6 can be a double-edged sword: interference in the IL-6-IL-6 receptor signaling may save patients from cytokine release storm (CRS), but can also weaken the anti-infectious immunity, particularly in rheumatic patients, who may have received a long-term treatment with immunosuppressive/modulatory agents. Thus, we suggest careful considerations before and close monitoring in the administration of tocilizumab in rheumatic patients with COVID-19. Besides tocilizumab, several disease-modifying antirheumatic drugs (DMARDs) can also be applied in the treatment of COVID-19. Therefore, we also reviewed and discussed the application of these DMARDs in COVID-19 condition.

DOI: 10.1007/s10067-020-05234-w
PubMed: 32562070
PubMed Central: PMC7303585

Affiliations:

Links toward previous steps (curation, corpus...)

to stream Main, to step Corpus: 001361
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Le document en format XML

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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged (MeSH)</term>
<term>Anti-Bacterial Agents (therapeutic use)</term>
<term>Antifungal Agents (therapeutic use)</term>
<term>Antirheumatic Agents (therapeutic use)</term>
<term>Antiviral Agents (therapeutic use)</term>
<term>Arthritis, Rheumatoid (complications)</term>
<term>Arthritis, Rheumatoid (drug therapy)</term>
<term>Aspergillosis (MeSH)</term>
<term>Aspergillus fumigatus (MeSH)</term>
<term>Betacoronavirus (MeSH)</term>
<term>COVID-19 (MeSH)</term>
<term>Coronavirus Infections (complications)</term>
<term>Coronavirus Infections (diagnostic imaging)</term>
<term>Coronavirus Infections (physiopathology)</term>
<term>Coronavirus Infections (therapy)</term>
<term>Cough (etiology)</term>
<term>Cytokine Release Syndrome (etiology)</term>
<term>Deprescriptions (MeSH)</term>
<term>Disease Progression (MeSH)</term>
<term>Dyspnea (etiology)</term>
<term>Female (MeSH)</term>
<term>Glucocorticoids (adverse effects)</term>
<term>Glucocorticoids (therapeutic use)</term>
<term>Humans (MeSH)</term>
<term>Hydroxychloroquine (therapeutic use)</term>
<term>Immunocompromised Host (MeSH)</term>
<term>Immunosuppressive Agents (adverse effects)</term>
<term>Immunosuppressive Agents (therapeutic use)</term>
<term>Interleukin-6 (blood)</term>
<term>Leflunomide (adverse effects)</term>
<term>Leflunomide (therapeutic use)</term>
<term>Lung (diagnostic imaging)</term>
<term>Lymphohistiocytosis, Hemophagocytic (diagnosis)</term>
<term>Lymphohistiocytosis, Hemophagocytic (etiology)</term>
<term>Lymphohistiocytosis, Hemophagocytic (immunology)</term>
<term>Methylprednisolone (therapeutic use)</term>
<term>Oxygen Inhalation Therapy (MeSH)</term>
<term>Pandemics (MeSH)</term>
<term>Pneumocystis carinii (MeSH)</term>
<term>Pneumonia, Pneumocystis (diagnosis)</term>
<term>Pneumonia, Pneumocystis (drug therapy)</term>
<term>Pneumonia, Pneumocystis (etiology)</term>
<term>Pneumonia, Pneumocystis (immunology)</term>
<term>Pneumonia, Viral (complications)</term>
<term>Pneumonia, Viral (diagnostic imaging)</term>
<term>Pneumonia, Viral (physiopathology)</term>
<term>Pneumonia, Viral (therapy)</term>
<term>Pulmonary Aspergillosis (diagnosis)</term>
<term>Pulmonary Aspergillosis (drug therapy)</term>
<term>Pulmonary Aspergillosis (etiology)</term>
<term>Pulmonary Aspergillosis (immunology)</term>
<term>Recurrence (MeSH)</term>
<term>SARS-CoV-2 (MeSH)</term>
<term>Tomography, X-Ray Computed (MeSH)</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr"><term>Antibactériens (usage thérapeutique)</term>
<term>Antifongiques (usage thérapeutique)</term>
<term>Antirhumatismaux (usage thérapeutique)</term>
<term>Antiviraux (usage thérapeutique)</term>
<term>Aspergillose (MeSH)</term>
<term>Aspergillose pulmonaire (diagnostic)</term>
<term>Aspergillose pulmonaire (immunologie)</term>
<term>Aspergillose pulmonaire (traitement médicamenteux)</term>
<term>Aspergillose pulmonaire (étiologie)</term>
<term>Aspergillus fumigatus (MeSH)</term>
<term>Betacoronavirus (MeSH)</term>
<term>Dyspnée (étiologie)</term>
<term>Déprescriptions (MeSH)</term>
<term>Femelle (MeSH)</term>
<term>Glucocorticoïdes (effets indésirables)</term>
<term>Glucocorticoïdes (usage thérapeutique)</term>
<term>Humains (MeSH)</term>
<term>Hydroxychloroquine (usage thérapeutique)</term>
<term>Immunosuppresseurs (effets indésirables)</term>
<term>Immunosuppresseurs (usage thérapeutique)</term>
<term>Infections à coronavirus (complications)</term>
<term>Infections à coronavirus (imagerie diagnostique)</term>
<term>Infections à coronavirus (physiopathologie)</term>
<term>Infections à coronavirus (thérapie)</term>
<term>Interleukine-6 (sang)</term>
<term>Lymphohistiocytose hémophagocytaire (diagnostic)</term>
<term>Lymphohistiocytose hémophagocytaire (immunologie)</term>
<term>Lymphohistiocytose hémophagocytaire (étiologie)</term>
<term>Léflunomide (effets indésirables)</term>
<term>Léflunomide (usage thérapeutique)</term>
<term>Méthylprednisolone (usage thérapeutique)</term>
<term>Oxygénothérapie (MeSH)</term>
<term>Pandémies (MeSH)</term>
<term>Pneumocystis carinii (MeSH)</term>
<term>Pneumonie à Pneumocystis (diagnostic)</term>
<term>Pneumonie à Pneumocystis (immunologie)</term>
<term>Pneumonie à Pneumocystis (traitement médicamenteux)</term>
<term>Pneumonie à Pneumocystis (étiologie)</term>
<term>Pneumopathie virale (complications)</term>
<term>Pneumopathie virale (imagerie diagnostique)</term>
<term>Pneumopathie virale (physiopathologie)</term>
<term>Pneumopathie virale (thérapie)</term>
<term>Polyarthrite rhumatoïde (complications)</term>
<term>Polyarthrite rhumatoïde (traitement médicamenteux)</term>
<term>Poumon (imagerie diagnostique)</term>
<term>Récidive (MeSH)</term>
<term>Sujet immunodéprimé (MeSH)</term>
<term>Sujet âgé (MeSH)</term>
<term>Tomodensitométrie (MeSH)</term>
<term>Toux (étiologie)</term>
<term>Évolution de la maladie (MeSH)</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Glucocorticoids</term>
<term>Immunosuppressive Agents</term>
<term>Leflunomide</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="blood" xml:lang="en"><term>Interleukin-6</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Anti-Bacterial Agents</term>
<term>Antifungal Agents</term>
<term>Antirheumatic Agents</term>
<term>Antiviral Agents</term>
<term>Glucocorticoids</term>
<term>Hydroxychloroquine</term>
<term>Immunosuppressive Agents</term>
<term>Leflunomide</term>
<term>Methylprednisolone</term>
</keywords>
<keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Arthritis, Rheumatoid</term>
<term>Coronavirus Infections</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Lymphohistiocytosis, Hemophagocytic</term>
<term>Pneumonia, Pneumocystis</term>
<term>Pulmonary Aspergillosis</term>
</keywords>
<keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Aspergillose pulmonaire</term>
<term>Lymphohistiocytose hémophagocytaire</term>
<term>Pneumonie à Pneumocystis</term>
</keywords>
<keywords scheme="MESH" qualifier="diagnostic imaging" xml:lang="en"><term>Coronavirus Infections</term>
<term>Lung</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Arthritis, Rheumatoid</term>
<term>Pneumonia, Pneumocystis</term>
<term>Pulmonary Aspergillosis</term>
</keywords>
<keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Glucocorticoïdes</term>
<term>Immunosuppresseurs</term>
<term>Infections à coronavirus</term>
<term>Léflunomide</term>
<term>Pneumopathie virale</term>
<term>Polyarthrite rhumatoïde</term>
</keywords>
<keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Cough</term>
<term>Cytokine Release Syndrome</term>
<term>Dyspnea</term>
<term>Lymphohistiocytosis, Hemophagocytic</term>
<term>Pneumonia, Pneumocystis</term>
<term>Pulmonary Aspergillosis</term>
</keywords>
<keywords scheme="MESH" qualifier="imagerie diagnostique" xml:lang="fr"><term>Infections à coronavirus</term>
<term>Pneumopathie virale</term>
<term>Poumon</term>
</keywords>
<keywords scheme="MESH" qualifier="immunologie" xml:lang="fr"><term>Aspergillose pulmonaire</term>
<term>Lymphohistiocytose hémophagocytaire</term>
<term>Pneumonie à Pneumocystis</term>
</keywords>
<keywords scheme="MESH" qualifier="immunology" xml:lang="en"><term>Lymphohistiocytosis, Hemophagocytic</term>
<term>Pneumonia, Pneumocystis</term>
<term>Pulmonary Aspergillosis</term>
</keywords>
<keywords scheme="MESH" qualifier="physiopathologie" xml:lang="fr"><term>Infections à coronavirus</term>
<term>Pneumopathie virale</term>
</keywords>
<keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Coronavirus Infections</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="sang" xml:lang="fr"><term>Interleukine-6</term>
</keywords>
<keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Coronavirus Infections</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="thérapie" xml:lang="fr"><term>Infections à coronavirus</term>
<term>Pneumopathie virale</term>
</keywords>
<keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Aspergillose pulmonaire</term>
<term>Pneumonie à Pneumocystis</term>
<term>Polyarthrite rhumatoïde</term>
</keywords>
<keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Antibactériens</term>
<term>Antifongiques</term>
<term>Antirhumatismaux</term>
<term>Antiviraux</term>
<term>Glucocorticoïdes</term>
<term>Hydroxychloroquine</term>
<term>Immunosuppresseurs</term>
<term>Léflunomide</term>
<term>Méthylprednisolone</term>
</keywords>
<keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Aspergillose pulmonaire</term>
<term>Dyspnée</term>
<term>Lymphohistiocytose hémophagocytaire</term>
<term>Pneumonie à Pneumocystis</term>
<term>Toux</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Aged</term>
<term>Aspergillosis</term>
<term>Aspergillus fumigatus</term>
<term>Betacoronavirus</term>
<term>COVID-19</term>
<term>Deprescriptions</term>
<term>Disease Progression</term>
<term>Female</term>
<term>Humans</term>
<term>Immunocompromised Host</term>
<term>Oxygen Inhalation Therapy</term>
<term>Pandemics</term>
<term>Pneumocystis carinii</term>
<term>Recurrence</term>
<term>SARS-CoV-2</term>
<term>Tomography, X-Ray Computed</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr"><term>Aspergillose</term>
<term>Aspergillus fumigatus</term>
<term>Betacoronavirus</term>
<term>Déprescriptions</term>
<term>Femelle</term>
<term>Humains</term>
<term>Oxygénothérapie</term>
<term>Pandémies</term>
<term>Pneumocystis carinii</term>
<term>Récidive</term>
<term>Sujet immunodéprimé</term>
<term>Sujet âgé</term>
<term>Tomodensitométrie</term>
<term>Évolution de la maladie</term>
</keywords>
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<front><div type="abstract" xml:lang="en">Recurrences of COVID-19 were observed in a patient with long-term usage of hydroxychloroquine, leflunomide, and glucocorticoids due to her 30-year history of rheumatoid arthritis (RA). Tocilizumab was applied and intended to target both COVID-19 and RA. However, disease of this patient aggravated after usage of tocilizumab. After the discussion of a multiple disciplinary team (MDT) including rheumatologists, antimicrobial treatments were applied to target the potential opportunistic infections (Pneumocystis jirovecii and Aspergillus fumigatus), which were authenticated several days later via high throughput sequencing. As an important cytokine in immune responses, IL-6 can be a double-edged sword: interference in the IL-6-IL-6 receptor signaling may save patients from cytokine release storm (CRS), but can also weaken the anti-infectious immunity, particularly in rheumatic patients, who may have received a long-term treatment with immunosuppressive/modulatory agents. Thus, we suggest careful considerations before and close monitoring in the administration of tocilizumab in rheumatic patients with COVID-19. Besides tocilizumab, several disease-modifying antirheumatic drugs (DMARDs) can also be applied in the treatment of COVID-19. Therefore, we also reviewed and discussed the application of these DMARDs in COVID-19 condition.</div>
</front>
</TEI>
<pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32562070</PMID>
<DateCompleted><Year>2020</Year>
<Month>08</Month>
<Day>20</Day>
</DateCompleted>
<DateRevised><Year>2021</Year>
<Month>01</Month>
<Day>10</Day>
</DateRevised>
<Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1434-9949</ISSN>
<JournalIssue CitedMedium="Internet"><Volume>39</Volume>
<Issue>9</Issue>
<PubDate><Year>2020</Year>
<Month>Sep</Month>
</PubDate>
</JournalIssue>
<Title>Clinical rheumatology</Title>
<ISOAbbreviation>Clin Rheumatol</ISOAbbreviation>
</Journal>
<ArticleTitle>A complex COVID-19 case with rheumatoid arthritis treated with tocilizumab.</ArticleTitle>
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<Abstract><AbstractText>Recurrences of COVID-19 were observed in a patient with long-term usage of hydroxychloroquine, leflunomide, and glucocorticoids due to her 30-year history of rheumatoid arthritis (RA). Tocilizumab was applied and intended to target both COVID-19 and RA. However, disease of this patient aggravated after usage of tocilizumab. After the discussion of a multiple disciplinary team (MDT) including rheumatologists, antimicrobial treatments were applied to target the potential opportunistic infections (Pneumocystis jirovecii and Aspergillus fumigatus), which were authenticated several days later via high throughput sequencing. As an important cytokine in immune responses, IL-6 can be a double-edged sword: interference in the IL-6-IL-6 receptor signaling may save patients from cytokine release storm (CRS), but can also weaken the anti-infectious immunity, particularly in rheumatic patients, who may have received a long-term treatment with immunosuppressive/modulatory agents. Thus, we suggest careful considerations before and close monitoring in the administration of tocilizumab in rheumatic patients with COVID-19. Besides tocilizumab, several disease-modifying antirheumatic drugs (DMARDs) can also be applied in the treatment of COVID-19. Therefore, we also reviewed and discussed the application of these DMARDs in COVID-19 condition.</AbstractText>
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<ForeName>Shaozhe</ForeName>
<Initials>S</Initials>
<AffiliationInfo><Affiliation>Department of Rheumatology and Immunology, Tongji Hospital, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, 430030, China.</Affiliation>
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<ForeName>Wei</ForeName>
<Initials>W</Initials>
<AffiliationInfo><Affiliation>Department of Stomatology, Union Hospital, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China.</Affiliation>
</AffiliationInfo>
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<ForeName>Ming</ForeName>
<Initials>M</Initials>
<AffiliationInfo><Affiliation>Department of Respiratory and Critical Care Medicine, Wuhan Pulmonary Hospital, No. 28 Baofeng Road, Wuhan, China. drliming1992@outlook.com.</Affiliation>
</AffiliationInfo>
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<AffiliationInfo><Affiliation>Department of Rheumatology and Immunology, Tongji Hospital, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, 430030, China. tjhdongll@163.com.</Affiliation>
</AffiliationInfo>
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<Language>eng</Language>
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<Agency>National Natural Science Foundation of China</Agency>
<Country></Country>
</Grant>
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<Month>06</Month>
<Day>19</Day>
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	Serveur d'exploration COVID et hydrochloroquine
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A complex COVID-19 case with rheumatoid arthritis treated with tocilizumab.

A complex COVID-19 case with rheumatoid arthritis treated with tocilizumab.

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