Role of tocilizumab for concomitant systemic fungal infection in severe COVID-19 patient: Case report.

Sari, Anggraini Permata; Darnindro, Nikko; Yohanes, Aryan; Mokoagow, Muhammad Ikhsan

RATIONALE Bacterial and fungal infections in Coronavirus Disease-19 (COVID-19) patients have been inadequately investigated and reported thus far. The safety profile of tocilizumab (TCZ) administration in candidemia patient still debatable. PATIENT CONCERNS A 54 year-old woman presenting with weakness on the left side of her body was diagnosed with COVID-19. After 7 days of admission, her condition worsened and developed respiratory distress and was having respiratory distress despite standard treatment. DIAGNOSES Acute respiratory distress syndrome (ARDS) in COVID 19 was diagnoses based on real time-PCR swab, deterioration of PaO2/FiO2 and increased of acute phase reactants. INTERVENTIONS Anti Interleukin-6 (IL-6) was considered to tackle her inflammatory condition. Prior to TCZ administration, blood culture was performed and the result came with Candida tropicalis in the absence of bacterial growth. OUTCOMES No major complications associated with intravenous antifungal or TCZ occurred. After 40 days of hospitalization, the patient's clinical condition improved and was finally discharged. LESSONS This case underscores the safety profile of giving TCZ in candidemia as a secondary infection in severe COVID-19 patient.