Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.10.009
Brazilian Journal of Anesthesiology
Case Report

Helmet mask and tocilizumab for a patient with hemophagocytic lymphohistiocytosis syndrome and COVID-19: a case report

Ahmet Eroglu, Seyfi Kartal, Ozlem Bayraktar Saral

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Abstract

The management of acute hypoxemic respiratory failure and the effect of antiviral drugs in patients with severe COVID-19 have been debated. This case presents the management of a 64-year-old man COVID-19 patient admitted to the Intensive Care Unit with fever, fatigue, shortness of breath and hemophagocytic lymphohistiocytosis syndrome. Helmet mask was successfully used to treat his hypoxemic respiratory failure without any aerosol problems. Tocilizumab, an antagonist interleukin-6, was intravenously infused as an alternative drug. After administration, the high level of IL-6, CRP, ferritin, D-dimer, triglyceride, and H-scores decreased, and the patient observed good clinical and laboratory improvements. In this case report, we describe the effect of noninvasive ventilation delivered by helmet mask and antiviral drugs, and the intravenous administration of tocilizumab in a patient with hemophagocytic lymphohistiocytosis syndrome and COVID-19.

Keywords

COVID-19;  Helmet mask;  Tocilizumab;  H-scores;  Hemophagocytic lymphohistiocytosis (HLH)

References

1 B.K. Patel, K.S. Wolfe, A.S. Pohlman, et al. Effect of noninvasive ventilation delivered by helmet vs face mask on the rate of endotracheal intubation in patients with Acute Respiratory Distress Syndrome: a randomized clinical trial JAMA, 315 (2016), pp. 2435-2441

2 J.M. Tonnelier, G. Prat, E. Nowak, et al. Non-invasive continuous positive airway pressure ventilation using a new helmet interface: a case-control prospective pilot study Intensive Care Med, 29 (2003), pp. 2077-2080

3 C. Zhang, Z. Wu, J.W. Li, et al. Cytokine release syndrome in severe COVID-19: interleukin-6 receptor antagonist tocilizumab may be the key to reduce the mortality Int J Antimicrob Agents, 55 (2020), Article 105954

4 F. Debaugnies, B. Mahadeb, A. Ferster, et al. Performances of the H-scores for diagnosis of hemophagocytic lymphohistiocytosiis in adults and pediatric patients Am J Clin Pathol, 145 (2016), pp. 862-870

5 L. Fardet, L. Galicier, O. Lambotte, et al. Development and validation of the HScore, a score for the diagnosis of reactive hemophagocytic syndrome Arthritis Rheumatol, 66 (2014), pp. 2613-2620
 

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Rev. Bras. Anestesiol.

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