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Antibacterials/chloroquine/tocilizumab Kidney and hepatic injury: case report

A 27-year-old man developed kidney and hepatic injury during treatment with amoxicillin, clarithromycin, azithromycin, chloroquine, meropenem, vancomycin and tocilizumab [not all dosages and routes stated]. The man was admitted with a week history of weakness, fever and sore throat. In view of these conditions, he was treated with amoxicillin and clarithromycin; however, no clinical improvement was noted. Upon admission, he reported fever, cough and dyspnoea. Nasal swab was obtained and reverse transcriptase-PCR assay confirmed SARS-CoV-2 infection. He started receiving an off-label treatment with chloroquine 500mg twice daily and azithromycin 500mg once daily. Due to suspicion of the lung abscess formation noted on the first chest X-ray, vancomycin was added to his regimen. Subsequently, a CT scan showed bilateral changes typical for COVID-19 pneumonia. Therefore, unspecified low molecular weight heparin was given in prophylactic doses. Within several hours from admission, his SpO2 dropped to 90%. Thereafter, he was diagnosed with acute respiratory distress syndrome. Hence, he was intubated and admitted to ICU. He received two infusion of tocilizumab 800mg. The second infusion of tocilizumab given after 8–12h. He was ventilated and received standard empiric antibiotic therapy with meropenem and his vancomycin therapy was continued. Subsequently, his body temperature normalised and CRP dropped. Four day after the initiation of tocilizumab, he developed hepatic injury in the form of transaminases and gamma-glutamyltransferase (GGTP) flair, as well as kidney injury. On the fifth day the his condition improved significantly and he was extubated. On day 21, he was discharged from the hospital after two negative SARS-CoV-2 RT-PCR from nasopharyngeal swabs. On day 35, a follow-up showed no radiological changes on chest X-ray, negative SASRCoV- 2 RT-PCR from nasopharyngeal swab. However, the level of IL-6 and alanine aminotransferase activity were increased [not all durations of treatments to reactions onsets stated]. Podlasin RB, et al. How to follow-up a patient who received tocilizumab in severe COVID-19: a case report. European Journal of Medical Research 25: No. 1, 2020. Available from: URL: http://doi.org/10.1186/s40001-020-00438-x

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Reactions 10 Oct 2020 No. 1825