{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:04:20Z","timestamp":1787504660010,"version":"build-2736575974"},"reference-count":23,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2022,5,27]],"date-time":"2022-05-27T00:00:00Z","timestamp":1653609600000},"content-version":"vor","delay-in-days":26,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Infection following SARS\u2010Co V\u20102\u00a0leading to COVID\u201019 disease is associated with significant morbidity and mortality. The clinical entity, COVID\u201019 cytokine storm syndrome (CSS) is a severe immunological manifestation of the disease associated with ominous consequences. Tocilizumab is interleukin\u20106 inhibitors that has been shown to hamper the catastrophic outcomes of CCS including the need for mechanical ventilation as well as reduce mortality, but the usage is limited by warnings of reactivation of potential latent infections or immune dysfunctions including severe neutropenia. We describe a case of 39\u2010year\u2010old Nepalese male patient with a background of scleritis maintained on azathioprine and rituximab therapy with normal baseline parameters including complete blood count who presented with acute COVID\u201019 infection including associated leukopenia as well as severe neutropenia (absolute neutrophil count of 300\u00a0cells\/\u00b5l), then progressed to critical disease culminating into CSS. Based on risks and benefits evaluation, the patient was treated with tocilizumab reinforced with granulocytes\u2010colony stimulating factor (G\u2010CSF, Filgrastim) to full recovery and safe outcome including reversal of neutropenia.<\/jats:p>","DOI":"10.1002\/ccr3.5932","type":"journal-article","created":{"date-parts":[[2022,5,27]],"date-time":"2022-05-27T04:56:01Z","timestamp":1653627361000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Dilemma of Tocilizumab therapy for a patient with critical COVID\u201019 disease and neutropenia: Case report and review of the literature"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3651-720X","authenticated-orcid":false,"given":"Ahmad","family":"Al Bishawi","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases Communicable Diseases Centre Hamad Medical Corporation  Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiema","family":"Abdalla","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy Communicable Diseases Center Hamad medical corporation  Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9117-3323","authenticated-orcid":false,"given":"Marwa","family":"Askar","sequence":"additional","affiliation":[{"name":"Department of Internal medicine Division of Family medicine Hamad medical corporation  Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wael","family":"Kanjo","sequence":"additional","affiliation":[{"name":"Department of Internal medicine Division of Internal Medicine Hamad Medical Corporation  Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amal","family":"Sameer","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Communicable Diseases Centre Hamad Medical Corporation  Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gihan","family":"Mustafa","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Communicable Diseases Centre Hamad Medical Corporation  Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamad","family":"Abdel Hadi","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Communicable Diseases Centre Hamad Medical Corporation  Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muna","family":"Al Maslamani","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Communicable Diseases Centre Hamad Medical Corporation  Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaaeldin","family":"Abdelmajid","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Communicable Diseases Centre Hamad Medical Corporation  Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,5,27]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cytogfr.2020.05.003"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.50674"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/tropicalmed5030112"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.01648"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40267\u2010020\u201000777\u2010z"},{"key":"e_1_2_10_7_1","doi-asserted-by":"crossref","unstructured":"MorrisAM StallNM BobosP et al.Tocilizumab for hospitalized patients with COVID\u201019. 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