COVID-19: A systemic disease treated with a wide-ranging approach: A case report

Main Article Content

Rosanna Massabeti
Maria Stella Cipriani
Ivana Valenti


coronavirus disease, COVID-19, treatment, monoclonal antibodies,, non-invasive mechanical ventilation


At the end of December 2019, the Health Commission of the city of Wuhan, China, alerted the World Health Organization (WHO) to a pneumonia cluster in the city. The cause was identified as being a new virus, later named SARS-CoV-2. We can distinguish three clinical phases of the disease with a distinct pathogenesis, manifestations and prognosis. Here, we describe the case of a 45-year-old male, successfully treated for Coronavirus disease (COVID-19). The patient was feeling sick in early April 2020; he had a fever and pharyngodynia. When he came to our COVID hospital, his breathing was normal. The nasopharyngeal swab specimen turned out positive. High-resolution computed tomography (HRCT) showed mild interstitial pneumonia. The patient was admitted to our department and treated with hydroxychloroquine, ritonavir, darunavir, azithromycin and enoxaparin. On day seven of the disease, the patient’s respiratory condition got worse as he was developing acute respiratory distress syndrome (ARDS). He was given tocilizumab and corticosteroids and was immediately treated with non-invasive mechanical ventilation (NIMV). His condition improved, and in the ensuing days, the treatment gradually switched to a high-flow nasal cannula (HFNC); after 18 days, the patient’s clinical condition was good.
The successful results we have been able to obtain are closely associated with avoidance of invasive ventilation that may lead to intensive care unit (ICU)-related superinfections. In our opinion, it is fundamental to understand that COVID-19 is a systemic disease that is a consequence of an overwhelming inflammatory response, which can cause severe medical conditions, even in young patients.

Abstract 1040 | PDF Downloads 651 HTML Downloads 42 XML Downloads 0


1. Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome Lancet Respir Med. 2020 Apr;8(4):420–22.

2. Cunningham AC, Goh HP, Koh D. Treatment of  COVID-19: Old tricks for new challenges. Crit  Care. 2020 Mar 16;24(1):91. https://doi. org/10.1186/s13054-020-2818-6

3. McGonagle D, Sharif K, O’Regan A, Bridgewood C. The role of cytokines including interleukin-6 in COVID-19 induced pneumonia and macrophage activation syndrome-like disease. Autoimmun Rev. 2020;102537. 2020.102537

4. Wilcox SR. Management of respiratory failure due to covid-19. BMJ. 2020 May 4;369:1786.

5. Zhang C, Wu Z, Li JW, et al. The cytokine release syndrome (CRS) of severe COVID-19 and Interleukin-6 receptor (IL-6R) antagonist Tocilizumab may be the key to reduce the mortality. Int J Antimicrob Agents. 2020 Mar 29;55(5): 105954. 105954

6. Moore JB, June CH. Cytokine release syndrome in severe COVID-19. Science. 2020 May 1;35(6490): 473–4.

7. De Luna G, Habibi A, Deux JF, et al. Rapid and severe covid-19 pneumonia with severe acute chest syndrome in a sickle cell patient successfully treated with tocilizumab. Am J Hematol. 2020 Apr 13;95:876–8.

8. Buonaguro FM, Puzanov I, Ascierto PA.Anti-IL6R role in treatment of COVID-19-related ARDS. J Transl Med. 2020 Apr 14;18(1):165.

9. Aziz M, Fatima R, Assaly R. Elevated Interleukin-6 and severe COVID-19: A meta-analysis. J Med Virol. 2020 Apr 28:1–3. https://

10. Liu B, Li M, Zhou Z. Can we use interleukin-6 (IL-6) blockade for coronavirus disease 2019 (COVID-19)-induced cytokine release syndrome (CRS)? J Autoimmun. 2020 Apr 10;111:102452.

11. Cellina M, Orsi M, Bombaci F, et al. Favorable changes of CT findings in a patient with COVID-19 pneumonia after treatment with tocilizumab. Diagn Interv Imaging. 2020 May; 101(5):323–324. 2020.03.010

12. Scavone C, Brusco S, Bertini M, et al. Current pharmacological treatments for COVID-19: What’s next? Br J Pharmacol. 2020 Apr 24:1–12.

13. Radbel J, Narayanan N, Bhatt PJ. Use of tocilizumab for COVID-19-induced cytokine release syndrome: A cautionary case report. Chest. 2020 Apr 25. in press

14. Michot JM, Albiges L, Chaput N, et al. Tocilizumab, an anti-IL6 receptor antibody, to treat Covid-19-related respiratory failure: A case report. Ann Oncol. 2020 Apr 2;31(7):961–4

15. Lazzeri M, Lanza A, Bellini R. Respiratory physiotherapy in patients with COVID-19 infection in acute setting: A Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR). Monaldi Arch Chest Dis. 2020 Mar 26;90(1):163–8. 2020.1285

16. AminJafari A, Ghasemi S. The possible of immunotherapy for COVID-19: A systematic review. Int Immunopharmacol. 2020 Apr 2;83:106455. 106455

17. Fu B, Xu X, Wei H. et al. Why tocilizumab could be an effective treatment for severe COVID-19? J Transl Med. 2020 Apr 14;18(1):164. https://doi. org/10.1186/s12967-020-02339-3

18. El Ghoch M, Valerio A. Let food be the medicine, but no not for coronavirus. Nutrition and  food science telling myths from facts. J  Popul Ther Clin Pharmaco. 2020;27(SP1): e1–e4.

19. Luo P, Liu Y, Qiu L, et al. Tocilizumab treatment in COVID-19: A single center experience. J Med Virol. 2020 Apr 6;92:814–18. 25801

20. Cao X. COVID-19: Immunopathology and its implications for therapy. Nat Rev Immunol. 2020  May;20(5):269–70. s41577-020-0308-3

21. Valentini M, Zmerly H. Antirheumatic drugs for COVID-19 treatment based on the phases of the disease: Current concept. J Popul Ther Clin Pharmaco. 2020;27(SP1):e14-e25.

22. Kumar GV, Jeyanthi V, Ramakrishnan S. A short review on antibody therapy for COVID-19. New Microbes New Infect. 2020 Apr 20:100682.

23. Zhang S, Li L, Shen A, Chen Y, et al. Rational use of tocilizumab in the treatment of novel coronavirus pneumonia. Clin Drug Investig. 2020 Apr 26;40: 511–18.