Tocilizumab
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Toxic erythema and eosinophilia: case report A 70-year-old man developed toxic erythema and eosinophilia during off-label therapy with tocilizumab for COVID-19. The man was hospitalised in Rome due to fever, asthenia, dry cough and dyspnoea. Following investigations, he was diagnosed with COVID-19 and started receiving off-label therapy with lopinavir/ritonavir and hydroxychloroquine 200mg twice a day. He also received oxygen supplementation, but his clinical conditions worsened after 7 days. Therefore, off label therapy with IV tocilizumab 600mg was initiated. Few hours after the administration of tocilizumab, he developed itching generalised cutaneous toxic erythemalike rash. His blood cell count revealed severe eosinophilia (2.2 x 109/L) with increasing trend. The man was treated with methylprednisolone with mild improvement. During the following days, his COVID-19 related symptoms underwent significant remission. His cell blood parameters also became normal, but eosinophil count was raised progressively. His skin rash was still present after 10 days. Skin eruption and blood eosinophilia integrate were two criteria for the diagnosis of drug reaction with eosinophilia and systemic symptoms syndrome (DRESS). The persistence of skin eruption and blood eosinophilia after withdrawal of suspect drug suggested DRESS. However, the rapid onset and absence of internal organ involvement ruled out DRESS. Skin biopsy and allergological tests were not performed because of the safety concerns. Sernicola A, et al. "Toxic erythema" and eosinophilia associated with tocilizumab therapy in a COVID-19 patient. Journal of the European Academy of Dermatology and 803500808 Venereology 34: e368-e370, No. 8, Aug 2020. Available from: URL: http://doi.org/10.1111/jdv.16620
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Reactions 12 Sep 2020 No. 1821
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