ciclesonide and favipiravir

We treated two patients with severe respiratory failure due to coronavirus disease 2019 (COVID-19). Case 1 was a 73-year-old woman, and Case 2 was a 65-year-old-man. Neither of them had a history of autoimmune disease. Chest computed tomography scans before the antiviral therapy showed bilateral multiple patchy ground-glass opacities (GGO) consistent with COVID-19 pneumonia. The GGO regressed over the course of the antiviral treatment; however, new non-segmental patchy consolidations emerged, which resembled those of interstitial lung disease (ILD), specifically collagen vascular disease-associated ILD. We tested the patients' sera for autoantibodies and discovered that both patients had high anti-SSA/Ro antibody titers. In Case 1, the patient recovered with antiviral therapy alone. However, in Case 2, the patient did not improve with antiviral therapy alone but responded well to corticosteroid therapy (methylprednisolone) and made a full recovery. The relationship between some immunological responses and COVID-19 pneumonia exacerbation has been discussed previously; our discovery of the elevation of anti-SSA/Ro antibodies suggests a contribution from autoimmunity functions of the immune system. Although it is unclear whether the elevation of anti-SSA/Ro antibodies was a cause or an outcome of aggravated COVID-19 pneumonia, we hypothesize that both patients developed aggravated the COVID-19 pneumonia due to an autoimmune response. In COVID-19 lung injury, there may be a presence of autoimmunity factors in addition to the known effects of cytokine storms. In patients with COVID-19, a high level of anti-SSA/Ro52 antibodies may be a surrogate marker of pneumonia severity and poor prognosis.

Topics: Aged; Amides; Antibodies, Antinuclear; Antiviral Agents; Benzamidines; Betacoronavirus; Coronavirus Infections; COVID-19; Female; Glucocorticoids; Guanidines; Humans; Hydroxychloroquine; Lung Diseases, Interstitial; Male; Methylprednisolone; Pandemics; Pneumonia, Viral; Pregnenediones; Pyrazines; Recovery of Function; Respiratory Distress Syndrome; Respiratory Insufficiency; SARS-CoV-2; Severity of Illness Index; Tomography, X-Ray Computed

Topics: Africa; Amides; Amodiaquine; Artesunate; Atazanavir Sulfate; Carbamates; Clinical Trials as Topic; COVID-19; COVID-19 Drug Treatment; COVID-19 Vaccines; Cytidine; Drug Approval; Drug Evaluation, Preclinical; Drug Repositioning; Drug Therapy, Combination; Humans; Hydroxylamines; Imidazoles; Ivermectin; Naphthyridines; Nitro Compounds; Pregnenediones; Pyrazines; Pyrrolidines; Ritonavir; Sample Size; Thiazoles; Valine; World Health Organization

We provide the details of the successful management of a patient with active Cushing's disease complicated with coronavirus disease 2019 (COVID-19) pneumonia. The patient was a 27-year-old Japanese female healthcare worker who was scheduled to undergo pituitary surgery for Cushing's disease. She had been in close contact with an undiagnosed patient infected with COVID-19 and then developed COVID-19 pneumonia. Despite a lack of known risk factors associated with severe COVID-19 infection, the patient's dyspnea worsened and her respiratory condition deteriorated, as indicated by the need for 7 L/min oxygen supply by mask to maintain her oxygen saturation at >90%. Medical treatment was initiated to control hypercortisolism by the 'block and replace' regimen using steroidogenesis inhibitors and hydrocortisone. The COVID-19 pneumonia improved with multi-modal treatment including antiviral therapy. One month later, after a negative severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) test result and with appropriate protection against virus transmission to medical staff in the operating room and daily medical care nurses, trans-sphenoidal surgery was performed by our highly experienced pituitary surgeon. One month after the surgery, the patient's basal ACTH and cortisol levels and urinary free cortisol were all under the detection limit. Surgical remission was expected. Since hypercortisolism due to active Cushing's disease may worsen a COVID-19 infection, multi-disciplinary management that includes appropriate and prompt treatment strategies is mandatory in such cases.

Topics: ACTH-Secreting Pituitary Adenoma; Adenoma; Adult; Amides; Benzamidines; Combined Modality Therapy; COVID-19; Dihydrotestosterone; Disease Progression; Female; Guanidines; Health Personnel; Heparin; Humans; Japan; Metyrapone; Neurosurgical Procedures; Pituitary ACTH Hypersecretion; Pregnenediones; Pyrazines; SARS-CoV-2; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

We describe a case of coronavirus disease 2019 (COVID-19) in a patient with mixed cellularity classical Hodgkin lymphoma (cHL) undergoing brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine (A+AVD) therapy. A 43-year-old man presented to our hospital with a complaint of fever, for which he was diagnosed with COVID-19 after a positive polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and antiviral therapy with favipiravir and ciclesonide was started subsequently. The fever persisted for the first few days of treatment, but his respiratory status was stable, and he became asymptomatic and afebrile on day 9. Although the PCR tests remained positive, he met the updated discharge criteria of the World Health Organization (WHO) on day 12. However, his fever recurred, and his condition worsened on day 16. A chest X-ray showed a new opacity. It is likely that favipiravir and ciclesonide treatment probably did not completely eliminate the virus in the patient, and therefore the infection persisted. We added remdesivir from day 21, and the improvement was remarkable. He was discharged on day 29 after two consecutive PCR test results were negative. PCR tests are not mandatory for the updated WHO discharge criteria. However, even after antiviral therapy, COVID-19 patients with hematologic malignancies may have prolonged active infection with impaired viral excretion. Depending on the background disease and comorbidities, there may be some patient populations for whom it is not appropriate to simply comply with the current discharge criteria. Therefore, more emphasis may be needed on PCR examinations.

Topics: Adenosine Monophosphate; Adult; Alanine; Amides; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Brentuximab Vedotin; COVID-19; COVID-19 Drug Treatment; COVID-19 Nucleic Acid Testing; Dacarbazine; Disease Progression; Doxorubicin; Hodgkin Disease; Humans; Male; Pregnenediones; Pyrazines; Time Factors; Vinblastine

Since December 2019, coronavirus disease 2019 (COVID-19) has been an international public health emergency. The possibility of COVID-19 should be considered primarily in patients with new-onset fever or respiratory tract symptoms. However, these symptoms can occur with other viral respiratory illnesses. We reported a case of severe acute respiratory syndrome coronavirus 2 and influenza A virus coinfection. During the epidemic, the possibility of COVID-19 should be considered regardless of positive findings for other pathogens.

Topics: Amides; Anti-Bacterial Agents; Antiviral Agents; Betacoronavirus; Coinfection; Coronavirus Infections; COVID-19; Diagnosis, Differential; Glucocorticoids; Humans; Influenza A virus; Influenza, Human; Lung; Male; Middle Aged; Pandemics; Pneumonia, Viral; Pregnenediones; Pyrazines; Radiography; Real-Time Polymerase Chain Reaction; SARS-CoV-2