Successful treatment of acute heart failure in COVID-19-induced cytokine storm with tocilizumab: A case report

Kalyan R. Chitturi; Sameer Thacker; Mukhtar A. Al-Saadi; Mahwash Kassi; Gianluigi Savarese; Giulia Ferrannini; Davide Stolfo; Christian Fielder Camm; Ross Thomson

doi:10.1093/ehjcr/ytaa188

Successful treatment of acute heart failure in COVID-19-induced cytokine storm with tocilizumab: A case report

Kalyan R. Chitturi, Sameer Thacker, Mukhtar A. Al-Saadi, Mahwash Kassi, Gianluigi Savarese, Giulia Ferrannini, Davide Stolfo, Christian Fielder Camm, Ross Thomson

Research output: Contribution to journal › Article › peer-review

14 Scopus citations

Abstract

SARS-CoV-2 is known to induce a cytokine storm, a hyperinflammatory state driven by up-regulation of interleukin 6 (IL-6) and immunomodulatory chemokines that may result in acute heart failure. Case summary: A 65-year-old woman with confirmed SARS-CoV-2 developed shock with multiorgan system failure, including acute biventricular heart failure, 2 weeks after the initial onset of fever, cough, and shortness of breath. The patient experienced myocardial recovery within 48 h after administration of tocilizumab, a humanized monoclonal anti-IL-6 receptor antibody, and multiple supportive vasoactive medications. Discussion: The differential diagnosis of acute heart failure in critically ill patients with COVID-19 infection is broad, including sepsis-induced cardiomyopathy, Takotsubo syndrome, viral lymphocytic myocarditis, and acute coronary syndrome. Immunomodulatory treatment with tocilizumab may benefit patients who develop cardiogenic shock associated with SARS-CoV-2-induced cytokine storm.

Original language	English (US)
Pages (from-to)	1-6
Number of pages	6
Journal	European Heart Journal - Case Reports
Volume	4
Issue number	FI1
DOIs	https://doi.org/10.1093/ehjcr/ytaa188
State	Published - Oct 1 2020

Keywords

COVID-19
Case report
Cytokine
Heart failure
Myocarditis
Takotsubo
Tocilizumab

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1093/ehjcr/ytaa188

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title = "Successful treatment of acute heart failure in COVID-19-induced cytokine storm with tocilizumab: A case report",

abstract = "SARS-CoV-2 is known to induce a cytokine storm, a hyperinflammatory state driven by up-regulation of interleukin 6 (IL-6) and immunomodulatory chemokines that may result in acute heart failure. Case summary: A 65-year-old woman with confirmed SARS-CoV-2 developed shock with multiorgan system failure, including acute biventricular heart failure, 2 weeks after the initial onset of fever, cough, and shortness of breath. The patient experienced myocardial recovery within 48 h after administration of tocilizumab, a humanized monoclonal anti-IL-6 receptor antibody, and multiple supportive vasoactive medications. Discussion: The differential diagnosis of acute heart failure in critically ill patients with COVID-19 infection is broad, including sepsis-induced cardiomyopathy, Takotsubo syndrome, viral lymphocytic myocarditis, and acute coronary syndrome. Immunomodulatory treatment with tocilizumab may benefit patients who develop cardiogenic shock associated with SARS-CoV-2-induced cytokine storm.",

keywords = "COVID-19, Case report, Cytokine, Heart failure, Myocarditis, Takotsubo, Tocilizumab",

author = "Chitturi, {Kalyan R.} and Sameer Thacker and Al-Saadi, {Mukhtar A.} and Mahwash Kassi and Gianluigi Savarese and Giulia Ferrannini and Davide Stolfo and {Fielder Camm}, Christian and Ross Thomson",

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AU - Chitturi, Kalyan R.

AU - Thacker, Sameer

AU - Al-Saadi, Mukhtar A.

AU - Kassi, Mahwash

AU - Savarese, Gianluigi

AU - Ferrannini, Giulia

AU - Stolfo, Davide

AU - Fielder Camm, Christian

AU - Thomson, Ross

N1 - © The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.

PY - 2020/10/1

Y1 - 2020/10/1

N2 - SARS-CoV-2 is known to induce a cytokine storm, a hyperinflammatory state driven by up-regulation of interleukin 6 (IL-6) and immunomodulatory chemokines that may result in acute heart failure. Case summary: A 65-year-old woman with confirmed SARS-CoV-2 developed shock with multiorgan system failure, including acute biventricular heart failure, 2 weeks after the initial onset of fever, cough, and shortness of breath. The patient experienced myocardial recovery within 48 h after administration of tocilizumab, a humanized monoclonal anti-IL-6 receptor antibody, and multiple supportive vasoactive medications. Discussion: The differential diagnosis of acute heart failure in critically ill patients with COVID-19 infection is broad, including sepsis-induced cardiomyopathy, Takotsubo syndrome, viral lymphocytic myocarditis, and acute coronary syndrome. Immunomodulatory treatment with tocilizumab may benefit patients who develop cardiogenic shock associated with SARS-CoV-2-induced cytokine storm.

AB - SARS-CoV-2 is known to induce a cytokine storm, a hyperinflammatory state driven by up-regulation of interleukin 6 (IL-6) and immunomodulatory chemokines that may result in acute heart failure. Case summary: A 65-year-old woman with confirmed SARS-CoV-2 developed shock with multiorgan system failure, including acute biventricular heart failure, 2 weeks after the initial onset of fever, cough, and shortness of breath. The patient experienced myocardial recovery within 48 h after administration of tocilizumab, a humanized monoclonal anti-IL-6 receptor antibody, and multiple supportive vasoactive medications. Discussion: The differential diagnosis of acute heart failure in critically ill patients with COVID-19 infection is broad, including sepsis-induced cardiomyopathy, Takotsubo syndrome, viral lymphocytic myocarditis, and acute coronary syndrome. Immunomodulatory treatment with tocilizumab may benefit patients who develop cardiogenic shock associated with SARS-CoV-2-induced cytokine storm.

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KW - Myocarditis

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Successful treatment of acute heart failure in COVID-19-induced cytokine storm with tocilizumab: A case report

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