ABSTRACT

Coronavirus diesase (COVID-19) infection is a fatal infection, caused by the acute respiratory failure syndrome-coronavirus-2 virus, which has spread worldwide all around the world. There are researches showing benefits of anti-cytokine treatments when macrophage activation syndrome (MAS) developed during COVID-19 infection. During the COVID-19 pandemic, tocilizumab treatment was applied to 10 patients, due to the development of MAS syndrome in their follow-up after a diagnosis of high probable or definitive COVID-19 infection in our hospital. When these cases were admitted, the SOFA score (mean ± standard deviation value) was 7.4±3.47, and the acute physiological and chronic health evaluation 2 score was 28±10.17. All patients had symptoms specific to COVID-19 pneumonia on lung tomography, and polymerase chain reaction positivity was accompanied in 8 cases. The cultures of 9 cases were pozitif in a way that supports the literature, and 1 case discharged from the intensive care unit having no culture positivity. COVID-19 infection was mortal in 7 cases, 2 cases were discharged and 1 patient continued to be treated in intensive care unit. In two of our discharged cases, after tosilizumab was given, a rapid improvement was observed when clinical and laboratory data were examined. Candida albicans/parapsylosis were detected both in peripheral blood and deep tracheal aspirate culture in one of the 4 cases diagnosed with fungal infection; one case in deep tracheal aspirate and in other case it were detected in urine culture.It is difficult to make a recommendation about COVID-19 infection yet, treatment algorithms are updated according to the results of the studies, and there are many ongoing studies. Due to the lack of sufficient data on long-term results and side effects in COVID-19 patients, we think that attention should be paid especially in terms of secondary infection development after tocilizumab use.

Keywords: COVID-19, tocilizumab, macrophage activation syndrome