Tocilizumab and Systemic Steroids in Severe COVID-19 with Acute Exacerbation of Idiopathic Pulmonary Fibrosis: A Case Report and Literature Review

Chung-Wen Huang；Chia-Min Chen；Ming-Ju Tsai；Tung-Chi Yeh；Wei-An Chang；Cheng-Hao Chuang；Chau-Chyun Sheu

AE-IPF ； COVID-19 ； tocilizumab ； IL-6 ； case report

胸腔醫學

39卷3期（2024 / 09 / 01）

228 - 233

英文

Tocilizumab, a potent interleukin-6 (IL-6) receptor antagonist, has demonstrated a survival benefit against severe COVID-19 in clinical trials. However, the safety and efficacy of its use in populations with multiple comorbidities are unknown. Here, we report a challenging case with acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) triggered by SARS-CoV-2 infection, which is the first ever presented. AE-IPF is commonly triggered by pulmonary infection, and results in a poor prognosis with limited treatment options. Superimposed SARS-CoV-2 infection may further complicate the management and outcome. Hesitation about the prescription of tocilizumab was resolved through comprehensive multidisciplinary discussions in our interstitial lung disease board. The rationale of tocilizumab prescription is based on flourishing data on the role of IL-6 in AE-IPF, and the potential benefit of fibroblast suppression in both in vivo and in vitro studies. Successful management with much improved oxygenation and pulmonary infiltration is documented and further supports the use of tocilizumab in such a complex situation. Since there is a scarcity of effective treatments for AE-IPF, investigations on the role of IL-6 antagonist in the management of AE-IPF are needed.