|
?:abstract
|
-
SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Initial clinical data from SARS-CoV-2 infection suggests two pathologic mechanisms of disease: one mediated by the virus itself and the other host response 1 A subset of patients develop severe disease that manifests as acute respiratory distress syndrome (ARDS), cytokine storm syndrome, and multi-organ failure Clinically, COVID-19 cytokine storm appears similar to macrophage activation syndrome (MAS)/secondary hemophagocytic lymphohistiocytosis (sHLH) 2 Findings such as fever, cytopenias, liver function derangement, coagulopathy, hypercytokinemia, hyperferritinemia, and elevated c-reactive protein may be present;however, the immunopathology appears to be “lung-centric” with concomitant ARDS and an absence of organomegaly, as is typically seen is MAS/sHLH 3 CASE PRESENTATION: We present a 77-year-old woman with history of chronic systolic heart failure and end-stage renal disease who was admitted to our medical intensive care unit with COVID-19 She was on minimal ventilator settings and low-dose vasopressors Her PaO2/FiO2 ratio was 412 Laboratory values from her two-day hospitalization are listed in Table 1 Notably, she was anemic and thrombocytopenic with significantly elevated transaminases, inflammatory markers, and D-dimer High-sensitivity troponins would significantly uptrend with new and progressive T wave inversions on serial electrocardiograms She was initiated on a heparin infusion for a non-ST elevation myocardial infarction An echocardiogram revealed a new reduction in her ejection fraction to 25% On day two of admission, a drop in the patient’s hemoglobin was noted, which prompted a CT of the abdomen and pelvis that showed a moderate-to-large right proximal thigh hematoma Simultaneous CT chest revealed scattered airspace disease with slight peripheral predominance and small bilateral pleural effusions She continued to require minimal ventilator support with a PaO2/FIO2 ratio of 305 Due to her progressive decline with worsening multi-organ failure and acute hemorrhage, the patient’s family decided to pursue comfort measures The patient subsequently expired DISCUSSION: Our patient represents a case of COVID-19 cytokine storm syndrome with multi-organ failure in the absence of ARDS, atypical of other cases described in the literature The data supports the use of anti-IL 6 therapy in the treatment of severe cytokine release syndrome of other etiologies, and recently, a study showed benefit with tocilizumab in COVID-19 cytokine storm 4 Our patient’s transaminitis precluded her enrollment in an interleukin (IL)-6 antagonist trial CONCLUSIONS: COVID-19 cytokine storm syndrome is associated with significant mortality and may occur even in the absence of ARDS IL-6 antagonists represent a promising therapeutic option for these patients, but larger studies are needed to confirm this data and the inclusion of patients with liver dysfunction should be entertained Reference #1: 1 Siddiqi HK, Mehra MR COVID-19 illness in native and immunosuppressed states: A clinical-therapeutic staging proposal J Heart Lung Transplant 2020;39:405-7 Reference #2: 2 Misra DP, Agarwal V, Gasparyan AY, Zimba O Rheumatologists\' perspective on coronavirus disease 19 (COVID-19) and potential therapeutic targets Clin Rheumatol 10 1007/s10067-020-05073-9 Reference #3: 3 McGonagle D, Sharif K, O\'Regan A, Bridgewood C The Role of Cytokines including Interleukin-6 in COVID-19 induced Pneumonia and Macrophage Activation Syndrome-Like Disease Autoimmun Rev 2020;19:102537 4 Luo P, Liu Y, Qiu L, Liu X, Liu D, Li J Tocilizumab treatment in COVID-19: A single center experience J Med Virol 10 1002/jmv 25801 DISCLOSURES: No relevant relationships by Lauryn Benninger, source=Web Response No relevant relationships by Diana Gomez Manjarres, source=Web Response No relevant relationships by Kyle White, source=Web Response
|
![[This page as RDF]](https://research.tib.eu/covid-19/static/rdf-icon.gif){kind=icon}