Michell Gulabani

Abstract

Tocilizumab (TCZ) is a promising treatment for management of COVID-19 pneumonia amid many controversies linked to its potential benefit. The exact time for administration of the drug to avail maximum clinical benefit is still unclear. We present a case series in which three patients with severe COVID 19 (respiratory rate of more than 30/min, breathlessness and hypoxia with Spo275 mg/dl, IL-6 > 200 pg/ml and ABG depicted falling trend in Pao2/Fio2 ratio despite adequate ventilation. These patients received TCZ nearly 9to 14 days of ICU stay after excluding secondary bacterial and fungal infections (sputum, urine and blood culture) as their inflammatory markers increased suddenly during the late phase of the disease. Their liver and kidney functions were acceptable and no neutropenia or thrombocytopenia was ensured. Their inflammatory markers improved significantly post intervention and they weaned from non-invasive ventilation, transferred from the intensive care unit to the ward and later discharged in 20-25 days from the hospital.Therefore, we would like to emphasize consideration of TCZ in worsening critically ill COVID-19 patients as a pharmacological modality even during late phase of the disease as a means to improve oxygenation, avoiding mechanical ventilation and subsequent morbidity and mortality. COVID 19 is a dynamically evolving disease and new treatment modalities at the different stages of the disease may yield benefits in certain sub-groups of patients.   Keywords: Tocilizumab, Cytokine storm, Interleukin­ 6, COVID­ 19.

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Abstract

Subacute Sclerosing panencephalitis (SSPE), also known as Dawson’s disease or measles encephalitis, is an extremely rare and fatal subacute infection caused by a persistent defective measles virus (MV). It mostly develops 7-10 years after initial MV infection and is fatal within 3 years from onset of symptoms.1 Measles virus infection before 2 years of age has 16 times higher risk of developing SSPE as compared to infection occurring after five years of age.2 SSPE is a progressive, degenerative disease of the central nervous system that occurs several years after measles infection. Saha et al reported an annual incidence of 21 per million population in India3 as compared to 2.4 per million population in the middle east.4-5  By this case report, we aim to stress on the certitude that the only definitive prevention against SSPE is timely measles vaccination. Keywords: SSPE, Measles, Vaccination.

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