oa Wits Journal of Clinical Medicine - Case study : a patient with asthma, Covid-19 pneumonia and cytokine release syndrome treated with corticosteroids and tocilizumab

Volume 2 Number Si1
  • ISSN : 2618-0189
  • E-ISSN: 2618-0197



Severe acute respiratory syndrome coronavirus-2 (SARSCoV- 2) is the novel coronavirus first detected in Wuhan, China, that causes coronavirus disease 2019 (Covid-19) and pneumonia. Covid-19 pneumonia is defined by a positive result for SARS-CoV-2 on a reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay of a specimen collected from the upper or lower respiratory tract together with radiological features of pneumonia and clinical features of hypoxaemia and dyspnoea. Although more than 80% of patients with Covid-19 infection have mild disease and make a full recovery, a significant proportion of patients progress to pneumonia, and about half of these cases will develop severe acute respiratory syndrome (ARDS). Initial reports from China suggested that age >65 years and medical comorbidities are risk factors for poor outcomes. The need for ICU admission and mechanical ventilation once ARDS develops is associated with a high mortality, ranging from 39% to 72%. Current guidelines recommend that corticosteroids or immunosuppressive therapy should not be used in patients with Covid-19 pneumonia unless there are other indications, such as shock, asthma or exacerbation of chronic obstructive pulmonary disease. However, the role of systemic corticosteroids is currently being re-evaluated in mechanically ventilated adults with ARDS, with some guidelines now suggesting their use.

We describe a case of a patient with Covid-19 infection, progressive pneumonia, development of a hyper-inflammatory state and cytokine release syndrome (CRS) who was successfully treated with steroids and tocilizumab.

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