Shinomiya Shohei, Nakase Keisuke, Fujii Ai, Takahara Yutaka, Adachi Hiroki, Okuro Masashi, Iinuma Yoshitsugu, Yokoyama Hitoshi, Ito Toru, Mizuno Shiro
Department of Respiratory Medicine, Kanazawa Medical University, Kahokugun, Japan.
Department of Nephrology, Kanazawa Medical University, Kahokugun, Japan.
SAGE Open Med Case Rep. 2021 Feb 1;9:2050313X21991063. doi: 10.1177/2050313X21991063. eCollection 2021.
In coronavirus disease 2019 pneumonia, a cytokine storm resulting from an excessive inflammatory response to the viral infection is thought to play a role in the exacerbation of the pneumonia and its prognosis. Favipiravir and ciclesonide are not effective in the inhibition of the cytokine storm. In this case report, we describe the experience of tocilizumab administration and polymyxin B immobilized fiber direct hemoperfusion in severe coronavirus disease 2019 pneumonia patient. A 52-year-old man presented with fever and dyspnea and was diagnosed with coronavirus disease 2019 pneumonia based on a polymerase chain reaction test. Mechanical ventilation and favipiravir administration were started for respiratory failure. However, favipiravir could not be continued due to hepatic dysfunction. Consequently, tocilizumab was administered, and continuous hemodiafiltration and endotoxin adsorption therapy (polymyxin B immobilized fiber direct hemoperfusion) were performed for acute renal failure. C-reactive protein decreased from 44 to 3.52 mg/dL, and the patient's respiratory status improved over time, enabling mechanical ventilation to be withdrawn. This case indicates that adding polymyxin B immobilized fiber direct hemoperfusion to tocilizumab administration may further increase efficacy in coronavirus disease 2019 treatment; however, more case-control studies are needed.
在2019冠状病毒病肺炎中，对病毒感染的过度炎症反应所导致的细胞因子风暴被认为在肺炎的加重及其预后中起作用。法匹拉韦和环索奈德对抑制细胞因子风暴无效。在本病例报告中，我们描述了在一名重症2019冠状病毒病肺炎患者中使用托珠单抗及多黏菌素B固定化纤维直接血液灌流的经验。一名52岁男性出现发热和呼吸困难，基于聚合酶链反应检测被诊断为2019冠状病毒病肺炎。因呼吸衰竭开始进行机械通气并给予法匹拉韦。然而，由于肝功能障碍无法继续使用法匹拉韦。因此，给予托珠单抗，并针对急性肾衰竭进行持续血液透析滤过和内毒素吸附治疗（多黏菌素B固定化纤维直接血液灌流）。C反应蛋白从44降至3.52mg/dL，患者的呼吸状况随时间改善，得以撤机。该病例表明，在使用托珠单抗的基础上加用多黏菌素B固定化纤维直接血液灌流可能会进一步提高2019冠状病毒病的治疗效果；然而，还需要更多的病例对照研究。
