Downing Sean, Chauhan Vivek, Chaudry Irshad H, Galwankar Sagar, Sharma Pushpa, Stawicki Stanislaw P
Department of Medicine, Sarasota Memorial Hospital, Sarasota, Florida, USA.
Department of Medicine, IGMC, Shimla, Himachal Pradesh, India.
J Glob Infect Dis. 2020 Nov 30;12(4):221-224. doi: 10.4103/jgid.jgid_296_20. eCollection 2020 Oct-Dec.
Since the beginning of the COVID-19 pandemic, many therapeutic strategies have been tried, with mixed results, to prevent and treat adult multisystem inflammatory syndrome in COVID-19 (AMIS-COVID-19). The reason behind this may the complex web of highly intertwined pathophysiologic mechanisms involved in the SARS-CoV-2 infection and the corresponding human systemic response, leading to end-organ damage, disability, and death. Colchicine, high-dose aspirin, and montelukast are being investigated currently as potential modulators of AMIS-COVID-19 in patients who fail to improve with traditional therapeutic approaches. Here, we present a patient who presented with high fevers, extreme fatigue and dyspnea, and ongoing deterioration. As part of our clinical approach, we used the simultaneous combination of the three agents listed above, capitalizing on their different respective mechanisms of action against AMIS-COVID-19. Following the initiation of therapy, the patient showed symptomatic improvement within 24 h, with the ability to return to daily activities after 72 h of continued triple-agent approach. Based on this experience, we have reviewed the immunomodulatory basis of this regimen, including potential avenues in which it may prevent the development of cytokine release syndrome (CRS) and its clinical manifestation, AMIS-COVID-19. By blocking the early stages of an inflammatory response, via diverse mechanistic pathways, the regimen in question may prove effective in halting the escalation of CRS and AMIS-COVID-19 in acutely symptomatic, nonimproving COVID-19 patients.
自新冠疫情开始以来，人们尝试了多种治疗策略来预防和治疗新冠成人多系统炎症综合征（AMIS-COVID-19），但结果喜忧参半。其背后的原因可能是，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染及其相应的人体全身反应涉及复杂且高度交织的病理生理机制网络，会导致终末器官损伤、残疾和死亡。目前正在研究秋水仙碱、高剂量阿司匹林和孟鲁司特，看它们能否作为传统治疗方法无效的AMIS-COVID-19患者的潜在调节剂。在此，我们介绍一位出现高热、极度疲劳和呼吸困难且病情持续恶化的患者。作为我们临床治疗方法的一部分，我们联合使用了上述三种药物，利用它们针对AMIS-COVID-19的不同作用机制。治疗开始后，患者在24小时内症状有所改善，在持续三联药物治疗72小时后能够恢复日常活动。基于这一经验，我们回顾了该治疗方案的免疫调节基础，包括其可能预防细胞因子释放综合征（CRS）及其临床表现AMIS-COVID-19的潜在途径。通过多种机制途径阻断炎症反应的早期阶段，该治疗方案可能对阻止急性症状性、病情无改善的新冠患者的CRS和AMIS-COVID-19病情升级有效。
