Voronezh, Russian Federation
employee from 31.12.2013 until now
Voronezh, Voronezh, Russian Federation
On the example of one clinical case, the effects of three immunotropic drugs: hydroxychloroquine, tocilizumab, and arthlegia on the course of cytokine storm in coronavirus infection were shown. Coronavirus refers to a systemic infec- tion, affecting not only the lungs and respiratory tract, but also other organs and systems: cardiovascular, immune, etc. The tactics of treatment depended on the feeding status of the patient. In this case, an elderly female patient (66 years old) had bronchial asthma and oncology in the anamnesis. The patient was transferred to an inpatient setting after 7 days of abnormal temperature (above 38°C). Lymphopenia, increased ESR (43 mm/h) were observed. Biochemical parameters also had deviations: the level of LDG was 606 U/l (the upper limit of the norm of 450 U/l), the level of IL-6 was slightly increased - 16.0 pg/ml (the norm of 0-10 pg/ml). At this stage of the disease, Novoclav was used to prevent bacterial infection, Dexamethasone, Cibor, and Hydroxychloroquine. After a week, the patient’s condition worsened significantly. Shortness of breath was observed, body temperature remained at 38.5°C, saturation decreased to 77%, the content of IL-6 exceeded 300 pg/ml, procalcitonin increased to 0.5 μg/l, C-reactive protein - to 67.5 mg/l, ferritin – up to 579 mg/ml that appropriated to the manifestation of symptoms of cytokine storm. An administration of the im- munotropic drug Tocilizumab within the next three days did not cause the decrease of parameters. The patient was begun non-invasive ventilation of lungs with the simultaneous appointment of another blocker of IL-6 - arthlegia (64 mg). During a day, the concentration of C-reactive protein and IL-6 decreased to normal. A week later, the patient’s condition became satisfactory, and she was discharged from the hospital with CT3 pulmonary lesion. We can say that the use of clinical biomarkers of inflammation (C-reactive protein and IL-6) allows us to make an individual program in the treatment of severe cases of coronavirus infection.
coronavirus, clinical signs, cytokine storm, therapy, antiviral drugs, Hydroxychloroquine, Tocilizumab
1. Kostinov M. P., Svitich O. A., Markelova E. V. Potencial'naya immunoprofilaktika COVID-19 u grupp vysokogo riska inficirovaniya. Vremennoe posobie dlya vrachey. M.: Gruppa MDV; 2020.
2. Paschenkov M. V., Haitov M. R. Immunnyy otvet protiv epidemicheskih koronavirusov. Immunologiya. 2020;41(5):5-18. doi:10.33029/0206-4952-2020-41-1-5-18.
3. Avdeev S. N., Careva N. A., Merzhoeva Z. M., Trushenko N. V., Yarosheckiy A. I. Prakticheskie rekomendacii po kislorodoterapii i respiratornoy podderzhke pacientov s COVID-19 na doreanimacionnom etape. Pul'monologiya. 2020;30(2):151-163. doi:10.18093/0869-0189-2020-30-2-151-163.
4. Charlson M. E., Pompei P., Ales K. L., Mac Kenzie C. R. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J. Chronic. Dis. 1987;40(5):373- 383. doi:10.1016/0021-9681(87)90171-8.
5. Yavelov I. S., Drapkina O. M. COVID-19: sostoyanie sistemy gemostaza i osobennosti antitromboticheskoy terapii. Kardiovaskulyarnaya terapiya i profilaktika. 2020;19(3):310-318.doi:10.15829/1728-8800-2020-2571.
6. Wei-jie Guan, Zheng-yi Ni, Yu Hu, Wen-hua Liang, Chun-quan Ou, Jian-xing He, Lei Liu, Hong Shan, Chun-liang Lei, David S.C. Hui, Bin Du, Lan- juan Li, Guang Zeng, Kwok-Yung Yuen, Ru-chong Chen, Chun-li Tang, Tao Wang, Ping-yan Chen, Jie Xiang, Shi-yue Li, Jin-lin Wang, Zi-jing Liang, Yi- xiang Peng, Li Wei, Yong Liu, Ya-hua Hu, Peng Peng, Jian-ming Wang, Ji-yang Liu, Zhong Chen, Gang Li, Zhi-jian Zheng, Shao-qin Qiu, Jie Luo, Chang-jiang Ye, Shao-yong Zhu, Nan-shan Zhong. Clinical Characteristics of Coronavirus Disease 2019 in China. Engl. J. Med. 2020;382(18):1708 –1720. doi:10.1056/NEJMoa2002032.
7. Barnaby Edward Young, Sean Wei Xiang Ong, Shirin Kalimuddin, Jenny G. Low, Seow Yen Tan, Jiashen Loh, Oon-Tek Ng, Kalisvar Marimuthu, Li Wei Ang, Tze Minn Mak, Sok Kiang Lau, Danielle E. Anderson, Kian Sing Chan, Thean Yen Tan, Tong Yong Ng, Lin Cui, Zubaidah Said, Lalitha Kurupatham, Mark I-Cheng Chen, Monica Chan, Shawn Vasoo, Lin-Fa Wang, Boon Huan Tan, Raymond Tzer Pin Lin, Vernon Jian Ming Lee Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore. JAMA. 2020;323(15):1488. doi:10.1001/ jama.2020.3204.
8. Fei Zhou, Ting Yu, Ronghui Du, Guohui Fan, Ying Liu, Zhibo Liu, Jie Xiang, Yeming Wang, Bin Song, Xiaoying Gu, Lulu Guan, Yuan Wei, Hui Li, Xudong Wu, Jiuyang Xu, Shengjin Tu, Yi Zhang, Hua Chen, Bin Cao. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-1062. doi:10.1016/S0140-6736(20)30566-3.
9. Villar J., Ferrando C., Martnnez D. Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial. Lancet Respir Med. 2020;8:267- 276.doi:10.1016/S2213-2600(19)30417-5.
10. Chaolin Huang, Yeming Wang, Xingwang Li, Lili Ren, Jianping Zhao, Yi Hu, Li Zhang, Guohui Fan, Jiuyang Xu, Xiaoying Gu, Zhenshun Cheng, Ting Yu, Jiaan Xia, Yuan Wei, Wenjuan Wu, Xuelei Xie, Wen Yin, Hui Li, Min Liu, Yan Xiao, Hong Gao, Li Guo, Jungang Xie, Guangfa Wang, Rongmeng Jiang, Zhancheng Gao, Qi Jin, Jianwei Wang, Bin Cao. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5.
11. Nanshan Chen, Min Zhou, Xuan Dong, Jieming Qu, Fengyun Gong, Yang Han, Yang Qiu, Jingli Wang, Ying Liu, Yuan Wei, Jia’an Xia, Ting Yu, Xinxin Zhang, Li Zhang. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507- 513. doi: 10.1016/S0140-6736 (20) 30211-7.
12. Dawei Wang, Bo Hu, Chang Hu, Fangfang Zhu, Xing Liu, Jing Zhang, Binbin Wang, Hui Xiang, Zhenshun Cheng, Yong Xiong, Yan Zhao, Yirong Li, Xinghuan Wang, Zhiyong Peng Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. Journal of the American Medical Association. 2020;323(11):1061-1069. doi:10.1001/ jama.2020.1585.
13. Thachil J., Tang N., Gando S., Falanga A., Cattaneo M., Levi M., Clark C., Iba T. ISTH interim guidance on recognition and management of coagulopathy in COVID-1. J. Thromb. Haemost. 2020;18(5):1023-1026. doi:10.1111/jth.14810.
14. Yildirim F. Ch loro quin e and Hydroxychloroquine in Treatment of COVID-19 Disease. J. Crit. Intensive Care. 2020;11(l.1):23−26. doi.org/10.37678/dcybd.2020.2387
15. Salama C., Han J., Yau L., Reiss W. G., Kramer B., Neidhart J. D., Criner G.J., Kaplan- Lewis E., Baden R., Pandit L., Cameron M. L., Garcia-Diaz J., Chbvez V., Mekebeb-Reuter M., Lima de Menezes F., Shah R., Gonzblez-Lara M. F., Assman B., Freedman J., Mohan S. V. Tocilizumab in Patients Hospitalized with Covid-19 Pneumonia. N. Engl. J. Med. 2021;384(1):20-30. doi: 10.1056/ NEJMoa2030340.
16. Coomes R. A., Haghbayan H. Interleukin-6 in COVID-19: A Systematic Review and Meta- Analysis. Rev. Med. Virol. 2020;30(6):1-9. doi:10.1002/rmv.2141.
17. Kumada H., Suzuki F., Suzuki Y., Toyota J., Karino Y., Chayama K., Kawakami Y., Fujiyama S., ItoT., Itoh Y., Tamura E., Ueki T., Ishikawa H., Hu W., McPhee F., Linaberry M., E. Hughes E. Randomized Comparison of Daclatasvir + Asunaprevir Versus Telaprevir + Peginterferon/ Ribavirin in Japanese Hepatitis C Virus Patients. J. Gastroenterol Hepatol. 2016;31(1):14-22. doi: 10.1111/jgh.13073.
18. Manli Wang, Ruiyuan Cao, Leike Zhang, Xinglou Yang, Jia Liu, Mingyue Xu, Zhengli Shi, Zhihong Hu, Wu Zhong, Gengfu Xiao. Remdesivir and chloroquine effectively inhibit the recently. Cell Research. 2020;30(3):269-271. doi:10.1038/ s41422-020-0282-0.
19. Beigel J. H., Tomashek K. M., Dodd L. E., Mehta A. K., Zingman B. S., Kalil A. C., Hohmann E., Chu H. Y., Luetkemeyer A., Kline S., Lopez de Castilla D., Finberg R. W., Dierberg K., Tapson V., Hsieh L., Patterson T. F., Paredes R., Sweeney D. A., Short W. R., Touloumi G., Lye D. C., Ohmagari N., Myoung-don Oh, Ruiz-Palacios G. M., Benfield T., Fdtkenheuer G., Kortepeter M. G., Atmar R. L., Buddy Creech C., Lundgren J., Babiker A. G., Pett S., Neaton J.D., Burgess T. H., Bonnett T., Green M., Makowski M., Osinusi A., Nayak S., Lane H.C. Remdesivir for the Treatment of Covid-19 — Final Report. N. Engl. J. Med. 2020;383(19):1813- 1826. doi:10.1056/NEJMoa2007764.
20. Tanaka T., Kishimoto T. The biology and medical implications of interleukin-6. Cancer Immunol Res. 2014;2(4):288-294. doi:10.1158/2326-6066.CIR-14-0022.
21. Rossi J.-F., Lu Z.-Y., Jourdan M., Klein B. Interleukin-6 as a therapeutic target. Clinical Cancer Research. 2015;21(6):1248-1257. doi: 10.1158/1078-0432.CCR-14-2291 9. Johnston S. L. Asthma and COVID-19: Is asthma a risk factor for severe outcomes? Allergy. 2020;75(7):1543-1545. doi:10.1111/all.14348.
