Single dose of subcutaneous tocilizumab in COVID-pneumonia:CT evidence of lymph nodal and parenchymal response

A 60-years-old man, smoker, with bipolar disorder and history of hypertension, diabetes, and obesity, presented with a 5-days fever (38°C) and cough. His physical examination revealed exertional dyspnea and polypnea; saturation was 95% room air. He came from a protected nurse residence where some COVID positive subjects were already identified and his nasopharyngeal swab documented COVID infection positivity. CT scan showed patchy ground-glass nodules in the right upper lobe and a mild subpleural ground glass in the superior segment of left lower lobe. Numerous mediastinal and hilar lymphadenopathies, the biggest in 4R (short axis: 13mm), 7 (short axis: 14mm). The patient was treated with hydroxychloroquine, azithromycin and methylprednisolone. However, few days later he got worse in terms of gas exchange and laboratory tests (PaO2/FiO2 < 100; lymphocytes: 420/μl; IL-6: 56 pg/ml), so that he received a subcutaneous injection of tocilizumab and was intubated. After that, he showed a progressive improvement confirmed by CT scan with reduction in size of all the lymph nodes and complete disappearance of pulmonary infiltrates This article is protected by copyright. All rights reserved.