Severe coronavirus disease 2019 in a patient with TAFRO syndrome: A case report. (November 2022)

• Record Type: Journal Article
• Authors: Oshima, Kengo; Kanamori, Hajime; Takei, Kentarou; Baba, Hiroaki; Tokuda, Koichi
• Is Part Of: Clinical infection in practice. Volume 16(2022)
• Publication Date: 2022-11
• Subjects: COVID-19 -- TAFRO syndrome -- ARDS -- Corticosteroid -- Sarilumab; Communicable diseases -- Periodicals; Infection -- Periodicals; Communicable Diseases; Infections; Communicable diseases; Infection; Electronic journals; Periodical; Electronic journals; Periodicals; 616.905
• DOI: 10.1016/j.clinpr.2022.100158
• Languages: English
• ISSNs: 2590-1702

Abstract

Highlights: We report a case of severe COVID-19 pneumonia in a patient with TAFRO syndrome. The patient was on moderate-dose corticosteroids & sarilumab before COVID-19 onset. Despite administration of oxygen and remdesivir, the patient developed ARDS. All immunomodulatory drugs were continued with an increase in glucocorticoid dose. High-flow nasal oxygen therapy with self-prone positioning aided COVID-19 recovery. Abstract: Background: TAFRO syndrome, a subtype of idiopathic multicentric Castleman disease, is an acute or subacute systemic inflammatory disease that causes fever, generalized oedema (pleural effusion or ascites), and thrombocytopenia and is associated with renal impairment, anaemia, and organomegaly (hepatosplenomegaly and lymph node enlargement). Coronavirus disease 2019 (COVID-19)-associated hyperinflammation is caused by dysregulation of proinflammatory cytokines. Cytokine storm syndrome is common to both COVID-19 and TAFRO syndrome. Case report. A 66-year-old man with TAFRO syndrome was admitted because of worsening renal function, right pleural effusion, and ascites. He was taking 20 mg prednisolone orally and 25 mg cyclosporin A orally twice daily. Despite administration of maximum oxygenation and remdesivir, the patient developed acute respiratory distress syndrome (ARDS) and was transferred to the intensive care unit. Results: Chest radiography showed bilateral lung infiltration. COVID-19 was confirmed with a positive polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2. Chest and abdominal computed tomography showed massive ground-glass opacities in both lungs, slight right pleural effusion, hepatomegaly, splenomegaly, and ascites. Conclusion: To the best of our knowledge, this is the first report of COVID-19 in a patient with TAFRO syndrome. Despite receiving a moderate dose of a corticosteroid and a monoclonal antibody against the IL-6 receptor, our patient developed severe pneumonia, suggesting that strong immunomodulatory therapy in the antiviral phase of COVID-19 may promote viral growth and induce ARDS.