Highlights • Immunothrombosis is the basis of many syndromes in patients with COVID-19. • The administration of thrombolysis and immunosuppression treatments could be a therapeutic option. • Concurrent recombinant tissue plasminogen activator (rt-PA) and tocilizumab infusion led to a significant improvement in the patient presented here. • The patient’s skin ischemia, cytokine release syndrome (CRS), and acute respiratory distress syndrome (ARDS) resolved. • Such therapeutic combinations could prove beneficial for patients with COVID-19. In a proportion of patients, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes a multisystem syndrome characterized by hyperinflammation, acute respiratory distress syndrome (ARDS), and hypercoagulability. A 68-year-old man with coronavirus disease 2019 (COVID-19) was admitted to the intensive care unit with respiratory failure, cytokine release syndrome (CRS), and skin ischemia – microthrombosis. Specific coagulation and inflammatory markers (D-dimer, ferritin, and C-reactive protein), along with the clinical picture, triggered the trial of recombinant tissue plasminogen activator (rt-PA) and tocilizumab. This was followed by resolution of the skin ischemia and CRS, while respiratory parameters improved. No major complications associated with rt-PA or tocilizumab occurred. The combination of rt-PA with targeted anti-inflammatory treatment could be a new therapeutic option for patients with COVID-19, ARDS, hyperinflammation, and increased blood viscosity.
【저자키워드】 Coronavirus disease 2019, acute respiratory distress syndrome, Tocilizumab, D-dimer, Recombinant tissue plasminogen activator,