• Damir Muhović, Jelena Bojović, Ana Bulatović, Batrić Vukčević, Marina Ratković, Ranko Lazović, and Brigita Smolović.
• Faculty of Medicine, University of Montenegro, Podgorica, Montenegro.
• Liver Int. 2020 Aug 1; 40 (8): 1901-1905.

Background And AimsTocilizumab (TCZ; interleukine-6 receptor antagonist) has been proposed to treat severe forms of Coronavirus disease-19 (COVID-19) because interleukine-6 plays an important role in COVID-19-induced cytokine storm. Several clinical studies have shown very good effects of TCZ in patients with COVID-19, with a few minor side effects reported. Only eight serious liver injuries caused by TCZ were reported before being used in the treatment of patients with COVID-19. Considering the significantly increased use of TCZ for the treatment of COVID-19, we would like to warn of its rare but possible serious hepatotoxicity, especially when used together with other hepatotoxic drugs.MethodsWe describe a patient with COVID-19-induced cytokine storm who developed drug-induced liver injury associated with the use of TCZ.ResultsOne day after TCZ administration, serum transaminase levels increased 40-fold. Nevertheless, TCZ had a positive effect on clinical and laboratory parameters in cytokine storm, with transaminases values normalizing in 10 days.ConclusionsThis is the first reported case of DILI caused by TCZ in a COVID-19 patient. Intensive liver function monitoring is imperative in COVID-19 patients, because of frequent polypharmacy with potentially hepatotoxic drugs.© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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