Tocilizumab in Severe COVID-19 Pneumonia and Concomitant Cytokine Release Syndrome

van Kraaij, Tom DA; Mostard, Rémy LM; Ramiro, Sofia; Magro Checa, Cesar; van Dongen, Christel MP; van Haren, Eric HJ; Buijs, Jacqueline; Landewé, Robert BM

Younger patients with COVID-19 may experience an exaggerated immune response to SARS-CoV-2 infection and develop cytokine release syndrome (CRS), which may be life threatening. There is no proven antiviral therapy for COVID-19 so far, but profound immunosuppression has recently been suggested as a treatment for COVID-19-associated CRS. We present a case of life-threatening CRS caused by COVID-19 infection with a favourable response to immunosuppressive therapy with tocilizumab (TCZ). The rapid clinical and biochemical improvement following TCZ administration suggests that treatment with immunotherapy can be life-saving in selected patients with COVID-19-induced CRS. LEARNING POINTS: Cytokine release syndrome may cause sudden and potentially life-threatening clinical deterioration in COVID-19 pneumonia, particularly in younger patients. Immunosuppressive therapy may provide important additional therapeutic benefit in these patients. Tocilizumab, a specific IL-6 inhibitor, led to dramatic clinical improvement in a young patient with severe COVID-19-associated cytokine release syndrome.