Abstract
The cytokine storm syndrome has been suggested as a mechanism in the pathophysiology of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2; COVID-19 [coronavirus disease 2019]) infection. Drugs such as tocilizumab, an interleukin-6 antagonist, have shown good results in other scenarios of hyperinflammatory state and might also be effective in COVID-19 disease. However, the best dosing regimen and the timing of infusion is currently unknown, specifically in obese patients. We report the first cases of tocilizumab administration in obese patients during the first days of COVID-19 worsening hypoxemia. This infusion was not adjusted by weight, following the manufacturer maximal dose limit. We kept a strict monitoring for possible infections, prior and during the treatment. All patients showed good improvements on chest-computed tomography images and oxygenation and were discharged from hospital shortly after, without complications or intubation. This case series highlights that tocilizumab seems to be effective to treat hyperinflammation of critical COVID-19 obese patients, even when the infusion of the ideal dose is not feasible to be administered. It also shows the importance of early timing in the decision to treat and the relevance of infections exclusion prior to the induction of immunosuppression by tocilizumab.
Keywords: COVID-19; case report; critical care; obesity; tocilizumab.
【저자키워드】 COVID-19, Critical care, Tocilizumab, obesity, Case report, 【초록키워드】 Treatment, SARS-CoV-2, coronavirus, Tocilizumab, hospital, Infection, interleukin-6, Immunosuppression, intubation, tomography, drug, Cytokine storm syndrome, COVID-19 disease, improvement, infections, pathophysiology, hyperinflammation, Patient, Complication, disease, Critical, mechanism, hyperinflammatory state, dose, Oxygenation, regimen, acute respiratory syndrome, COVID-19 obese patients, obese patients, tocilizumab administration, treat, exclusion, Administered, effective, limit, highlight, shown, case sery, adjusted, suggested, feasible, discharged, maximal dose, obese patient, the timing, worsening hypoxemia, 【제목키워드】 Sery,