Additionally, our patient did not present clinical or biological evidence of bacterial surinfection or other opportunistic infection after the introduction of tocilizumab
Additionally, our patient did not present clinical or biological evidence of bacterial surinfection or other opportunistic infection after the introduction of tocilizumab. The reporting of this study conforms to the CARE guidelines. 13 Conclusion Patients with hematologic malignancies represent a major challenge for practitioners during this pandemic because SARS-CoV-2 infection and hematologic malignancies overlap in several common points, mainly that of immunity. Footnotes Consent for publication and ethics approval: The patient described in this report provided both verbal and written consent for publication. use of tocilizumab in patients with hematologic malignancies who develop SARS-CoV-2 infection, although a few cases of patients with multiple myeloma have been reported. To our knowledge, however, this is the first report of a SARS-CoV-2Cinfected patient in the blast phase of chronic myeloid leukemia who had a favorable response to treatment with tocilizumab. The management of patients with hematological malignancies who become infected with SARS-CoV-2 is a major challenge for practitioners, necessitating more specific research in this direction. infection sensitive to amoxicillin/clavulanic acid. The levofloxacin was stopped and the 7-day course of amoxicillin/clavulanic acid was completed. On day 6, the patient reported more severe respiratory difficulties even under high-concentration oxygen mask therapy, and his PaO2 was 37?mmHg on oxygen. A chest computed tomography scan with and without injection (Figure 1(b)) showed Teniposide an increased number of ground-glass lesions with an estimated involvement of 85% and no signs of pulmonary embolism or gas effusion. We administered high-flow nasal oxygen therapy with a flow rate of 50?L/minute and a fraction of inspired oxygen (FiO2) of 70%, and the patient underwent prone sessions lasting 16 hours per day. The patients SpO2 was stabilized at 86% to 90%. The kinetics of ferritin, LDH, CRP, and D-dimer were increasing, and the interleukin 6 (IL-6) concentration was measured for the first time and was found to be very high (Figure 2). Open in a separate window Figure 2. Evolution of inflammatory marker kinetics before and after the introduction of tocilizumab. On day 8, the patients SpO2 dropped again to 76% despite high-flow nasal oxygen therapy in the prone position. His PaO2 was 36?mmHg. The patients condition was too unstable to perform thoracic imaging. Transthoracic ultrasound showed no abnormalities, and pleural ultrasound showed no evidence of pneumothorax. The patient was put Teniposide on noninvasive ventilation with a positive end-expiratory pressure of 8?cmH2O, asynchrony index of 8?cmH2O, and FiO2 of Teniposide 90%. Blood gas analysis 3 hours later showed a PaO2 of 57.7?mmHg and PaO2/FiO2 of 64.1; thus, the patient was in a very critical state. Another biological workup showed continuous elevation of ferritin, LDH, CRP, and IL-6 (Figure 2). The decision was made to introduce tocilizumab despite scant reports of its use in patients with leukemia. The patient received 400?mg of tocilizumab on day 10. This treatment resulted in an improvement in the patients respiratory level, and his PaO2/FiO2 ratio increased to 167. He was successfully weaned from the NIV on day 13 and placed on high-flow nasal oxygen therapy with a flow rate of 55?L/minute FHF4 and FiO2 of 60%. Biologically, the kinetics of ferritin, LDH, CRP, and IL-6 were decreasing (Figure 2). On day 20, we were able to treat the patient with a high-concentration oxygen mask with a flow rate of 15 L/minute associated with sessions of the prone position with an SpO2 of 87%. Clinically, the patient was well at this point. His biological workup showed a slight increase in the ferritin, CRP, D-dimer, and LDH concentrations. The blood count still showed lymphopenia at 870/L with thrombocytopenia at 50/L, requiring a reduction in the anticoagulation therapy to a preventive dose. On day 27, the patient was transferred to the hematology department with a very good respiratory condition using only oxygen goggles with a flow rate of 5?L/minute, and his SpO2 was 90%. Discussion In December 2019, the world experienced the emergence of SARS-CoV-2, a new strain in the family of beta-coronaviruses that causes COVID-19. This virus caused millions of deaths due to SARS, causing the world to enter a state of high alert. In February 2020, the World Health Organization declared SARS-CoV-2 infection as a pandemic. 1 This novel coronavirus has spread to 216 countries, requiring the implementation of general containment. The world has already experienced two epidemics caused by coronaviruses: SARS-CoV in 2002 and 2003 and Middle East respiratory syndrome-coronavirus (MERS-CoV) in 2013. However, SARS-CoV-2 is characterized by higher transmission, a greater variety of clinical manifestations, and higher mortality compared with SARS-CoV and MERS-CoV, and this is explained.