Severe COVID-19 Pneumonia Treated by Intensive Immune Suppression Therapy With a Combination of Steroid Pulse and Tocilizumab Followed by a Tapering Dose of Steroid Therapy During the Delta (B.1.617.2) Variant Outbreak: A Successfully Treated Case

• Published in: Curēus (Palo Alto, CA) Vol. 13; no. 11; p. e19340
• Main Authors: Muramatsu, Ken-Ichi, Ishikawa, Kouhei, Komatsu, Arisa, Jitsuiki, Kei, Yanagawa, Youichi
• Format: Journal Article
• Language: English
• Published: United States Cureus Inc 07.11.2021; Cureus
• Subjects: Anesthesia; Antibiotics; Anticoagulants; Antiviral drugs; Blood; Case reports; Coronaviruses; COVID-19; Creatinine; Cytokine storm; Dehydrogenases; Extracorporeal membrane oxygenation; Heart rate; Hemoglobin; Hospitals; Illnesses; Infectious Disease; Internal Medicine; Lungs; Monoclonal antibodies; Mortality; Patients; Pneumonia; Pulmonology; Respiratory distress syndrome; Steroids; Ventilators; Japan; covid-19; organizing pneumonia; steroid pulse; tocilizumab; delta variant
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.19340

A 55-year-old man developed a low-grade fever (day 1). His wife had already been infected with COVID-19 four days previously and he had been isolated in his house as a close contact. Polymerase chain reaction for COVID-19 was positive. He had untreated diabetes mellitus. On day 7, his percutaneous saturated oxygen fell to <70% and he was transported to a hospital by ambulance. He underwent tracheal intubation, mechanical ventilation, and treatments with half steroid pulse, tocilizumab, remdesivir, and heparin. However, his ratio of arterial oxygen partial pressure to fractional inspired oxygen (P/F ratio) decreased to 120 under mechanical ventilation and he was transported to our hospital. On arrival, he did not synchronize with mechanical ventilation well. Initially, he was treated using a muscle relaxant and deep sedation to facilitate complete synchronization with mechanical ventilation and his P/F ratio improved to 247; thus, he was treated with mechanical ventilation alone with intermittent placement in the prone position. In addition, he was treated with steroid pulse therapy after steroid tapering therapy for nearly one month, glycyrrhizin, γ-globulin, azithromycin, and heparin. On day 20, the tracheal tube was removed after the improvement of the P/F ratio. We herein present the case of a patient with severe COVID-19 pneumonia who survived following treatment by intensive immune suppression therapy, including the combination of steroid pulse and tocilizumab, followed by a tapering dose of steroid therapy, after an outbreak of COVID-19 Delta variant. Further studies are needed to investigate the usefulness of this regimen.