The influence of immunotropic drugs on the cytokine storm in coronavirus infection (on the example of a clinical case)

On the example of one clinical case, the effects of three immunotropic drugs: hydroxychloroquine, tocilizumab, and arthlegia on the course of cytokine storm in coronavirus infection were shown. Coronavirus refers to a systemic infec- tion, affecting not only the lungs and respiratory tract, but also other organs and systems: cardiovascular, immune, etc. The tactics of treatment depended on the feeding status of the patient. In this case, an elderly female patient (66 years old) had bronchial asthma and oncology in the anamnesis. The patient was transferred to an inpatient setting after 7 days of abnormal temperature (above 38°C). Lymphopenia, increased ESR (43 mm/h) were observed. Biochemical parameters also had deviations: the level of LDG was 606 U/l (the upper limit of the norm of 450 U/l), the level of IL-6 was slightly increased - 16.0 pg/ml (the norm of 0-10 pg/ml). At this stage of the disease, Novoclav was used to prevent bacterial infection, Dexamethasone, Cibor, and Hydroxychloroquine. After a week, the patient’s condition worsened significantly. Shortness of breath was observed, body temperature remained at 38.5°C, saturation decreased to 77%, the content of IL-6 exceeded 300 pg/ml, procalcitonin increased to 0.5 μg/l, C-reactive protein - to 67.5 mg/l, ferritin – up to 579 mg/ml that appropriated to the manifestation of symptoms of cytokine storm. An administration of the im- munotropic drug Tocilizumab within the next three days did not cause the decrease of parameters. The patient was begun non-invasive ventilation of lungs with the simultaneous appointment of another blocker of IL-6 - arthlegia (64 mg). During a day, the concentration of C-reactive protein and IL-6 decreased to normal. A week later, the patient’s condition became satisfactory, and she was discharged from the hospital with CT3 pulmonary lesion. We can say that the use of clinical biomarkers of inflammation (C-reactive protein and IL-6) allows us to make an individual program in the treatment of severe cases of coronavirus infection.