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Nevertheless, TCZ had a positive effect on clinical and laboratory parameters in cytokine storm, with transaminases values normalizing in 10 days. Two weeks later, he developed a fever up to He required mechanical ventilation and was transferred to the intensive care unit ICU. For the first 4 days of treatment in ICU, the patient was sedated, mechanically ventilated, with stable vital parameters. Six days after admission to the ICU, the patient's condition worsened and the control chest radiography showed the signs of disease progression.
All microbiological analyses serology on hepatotropic viruses, hemoculture on aerobic and anaerobic bacteria, urine culture were negative.
Based on clinical, radiological and laboratory analyses, he met all the criteria CRS and treatment with TCZ, according to the Chinese 4 and Lombardian 5 protocols. Subsequently, the patient's condition is complicated by bilateral pneumothorax and subcutaneous emphysema Figure 1. The pneumothorax was treated with drain thoracostomy. Comparing the previous MSCT finding, the effect of tocilizumab on the parenchymal recovery of the lungs could not be assessed because of the collapsed lung affected by the pneumothorax.
To date, despite the laboratory recovery and the cessation of CRS, his condition is still critical owing to the pulmonary issues. The most common side effects of TCZ are upper respiratory symptoms, headache and hypertension. Serious side effects are rare: severe infections, acute liver injuries, cytopenia, gastrointestinal ulcerations and perforations.
