Ocrelizumab
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SARS-CoV-2 pneumonia: 2 case reports In a case series a 36-year-old woman and a 54-year-old man were described who developed SARS-CoV-2 pneumonia following treatment with ocrelizumab for multiple sclerosis [dosages not stated]. Case-1: The woman was admitted on 29 March 2020 with a 4 day history of fever, dry cough and coryza. Previously, her husband was diagnosed with SARSCoV-2 infection. Her past medical history was significant for papillary thyroid carcinoma in 2014, HPV infection and highly active relapsing remitting multiple sclerosis in 2018. On March 2019, she started receiving ocrelizumab (last infusion was in September 2019). On admission, she tested positive for SARS-CoV-2 infection on RT-PCR of a NPh swab. Her chest CT revealed presence of a single ground-glass area in the subpleural region of the inferior lobe of the left lung. Other viral and bacterial infections were excluded. Thus, a diagnosis of SARS-CoV-2 pneumonia was confirmed. She started receiving off label treatment with hydroxychloroquine [Plaquenil] 200mg twice a day for 10 days and lopinavir/ritonavir 400/100mg twice a day for 12 days. After 8 days of hospitalisation, a repeat chest CT showed bilateral ground-glass opacities of the lungs. D-dimers were found to be elevated concomitantly with the worsening of lung infiltrates and tended to normalise with the resolution of pneumonia. Later, she was discharged in a good clinical condition. After 19 days from the onset of symptoms, she tested negative on two NPh swabs for SARS-CoV-2 RTPCR. Follow-up chest CT at 27 days after the onset of symptoms revealed complete resolution of lung ground glass opacities. Case-2: A 54-year-old man was admitted on 04 April 2020 with a 5 day history of fever. Prior to the admission, he was living in a nursing home, where cases of COVID-19 have been diagnosed. His past medical history was significant for secondary progressive multiple sclerosis in 2003. He received first line treatment with interferon beta 1a from 2004 to 2011 and then second line treatment with fingolimod from 2011 to 2017. In 2018, he experienced a deep venous thrombosis, which was treated with rivaroxaban and inferior vena cava filter was placed to prevent pulmonary embolism. On November 2018, he started ocrelizumab (last infusion was in November 2019). On admission, he tested positive for SARS-CoV-2 infection on RT-PCR assay of a NPh swab. Chest CT revealed presence of widespread bilateral ground-glass opacities. Other viral and bacterial infections were ruled out. Thus a diagnosis of SARS-CoV-2 pneumonia was made. A repeat chest CT was performed after 8 days of admission revealed the extension of bilateral ground-glass opacities of the lungs and chest CT performed after 24 days showed complete resolution. Leukocyte count and CD4 absolute counts were decreased during the admission. Where as CRP, D-dimers and fibrinogen increased concomitantly with the extension of lung infiltrates and then normalised with the resolution of pneumonia. Later, he was discharged in a good clinical condition.
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