• Ajaya Basnet, Mahendra Raj Shrestha, Rossu Thapa, Basanta Tamang, Apurba Shrestha, Prabhat Rawal, Duwal ShresthaSailendra KumarSKDepartment of Orthopedic and Trauma Services, Nepal Armed Police Force Hospital, Balambu, Kathmandu, Nepal., Lochan Karki, and Shiba Kumar Rai.
• Department of Medical Microbiology, Shi-Gan International College of Science and Technology, Maharajgunj, Kathmandu, Nepal.
• JNMA J Nepal Med Assoc. 2022 Aug 1; 60 (252): 727731727-731.

UnlabelledThe in-hospital mortality in patients with COVID-19 could be correlated with severe acute respiratory syndrome coronavirus-2 induced hyper-inflammation, which is attributed to an unconstrained inflammatory cytokine storm. The pro-inflammatory cytokine, specifically, interleukin-6 plays a prominent role in the cytokine storm and may result in alveolar-capillary blood-gas exchange dysfunction. Therefore, the method to block the signal transduction pathway of interleukin-6 could be a potential treatment for severe COVID-19 patients. In this case series of three patients with severe COVID-19, we focus on the rationale for utilization of tocilizumab, an anti-interleukin-6 receptor antibody, which could block the signal transduction pathway of interleukin-6. The observations from this study allowed us to hypothesize that the infusions of tocilizumab may not reduce the elevated level of interleukin-6, and hence may not be a significant therapeutic for reducing in-hospital mortality associated with COVID-19. Additionally, it could also be speculated that interleukin-6 may not be a potentially actionable target cytokine to treat COVID-19-associated cytokine storms.KeywordsCOVID-19; cytokines; interleukin-6.

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