• J Formos Med Assoc · Sep 2021

    Case Reports

    Combined intravenous immunoglobulin and baricitinib treatment for severe COVID-19 with rhabdomyolysis: A case report.

    • Hao-Yu Wu, Chien-Ting Pan, Chiao-Feng Cheng, Chi-Ying Lin, Sheng-Nan Chang, Yi-Chung Chen, Chih-Yuan Wang, Yen-Fu Chen, Chung-Yu Chen, Matthew Huei-Ming Ma, and Juey-Jen Hwang.
    • Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
    • J Formos Med Assoc. 2021 Sep 1; 120 (9): 177717811777-1781.

    AbstractSince December 2019, the outbreak of coronavirus disease 2019 (COVID-19) has spread rapidly around the world. The severity of COVID-19 ranges from asymptomatic carriers to severe acute respiratory distress syndrome (ARDS). Accumulating evidence has shown that COVID-19 may be associated with multiple organ complications including cardiac injury, viral myositis and neurological deficits. Numerous laboratory biomarkers including lymphocytes, platelets, lactate dehydrogenase and creatine kinase (CK) have been associated with the prognostic outcomes of patients with COVID-19. However, dynamic correlations between levels of biomarkers and clinical course have not been studied. Herein, we report a 74-year-old female patient with severe COVID-19 which progressed to ARDS requiring intubation and mechanical ventilation. The laboratory findings showed lymphopenia, hypogammaglobulinemia, and elevated inflammatory biomarkers and CK. She received intensive therapy with hydroxychloroquine, lopinavir/ritonavir, and azithromycin with limited effects. Immunomodulatory treatments with high dose intravenous immunoglobulin and baricitinib were prescribed with satisfactory biochemical, radiographic and clinical recovery. We found an interesting correlation between serum CK elevation and inflammatory biomarkers, which reflected clinical improvement. This case demonstrates that inflammatory biomarkers, cytokines, and CK level correlated with disease severity and treatment response, and combined use of intravenous immunoglobulin and baricitinib is a potential treatment in patients with severe COVID-19.Copyright © 2021 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.

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