{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T11:37:41Z","timestamp":1761824261010,"version":"3.44.0"},"reference-count":10,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2021,1,8]],"date-time":"2021-01-08T00:00:00Z","timestamp":1610064000000},"content-version":"unspecified","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,12,2]]},"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:p>As of 28 October 2020, there are over 44\u2009000\u2009000 confirmed COVID-19 infections and over 1\u2009000\u2009000 deaths worldwide, including 945\u2009367 infections and 45\u2009765 deaths in the UK. Acute respiratory distress syndrome occurs in 50% of patients with secondary haemophagocytic lymphohistiocytosis, a hyperinflammatory syndrome characterised by a surge of cytokines, including interleukin 6 (IL-6). Here we describe the case of the first patient with severe COVID-19 pneumonia successfully treated with tocilizumab, a humanised monoclonal antibody against the IL-6 receptor, in the UK. Early treatment (after 7\u201310 days from the onset of symptoms) with tocilizumab could (1) reduce the risk of requiring non-invasive or invasive ventilation; (2) offer a chance of survival to people who are not fit for escalation or have refused to be ventilated; and (3) potentially increase the chance of survival in some patients who are already ventilated but fail to improve with supportive treatment.<\/jats:p>","DOI":"10.1136\/bcr-2020-238210","type":"journal-article","created":{"date-parts":[[2021,1,8]],"date-time":"2021-01-08T13:47:51Z","timestamp":1610113671000},"page":"e238210","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Successful treatment of severe COVID-19 pneumonia and hyperinflammatory syndrome with tocilizumab"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1260-8307","authenticated-orcid":false,"given":"Giorgio","family":"Gentile","sequence":"first","affiliation":[{"name":"Nephrology, Royal Cornwall Hospitals NHS Trust, Truro, UK"},{"name":"University of Exeter Medical School, Exeter, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"Davies","sequence":"additional","affiliation":[{"name":"Nephrology, Royal Cornwall Hospitals NHS Trust, Truro, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valeria Maria","family":"Manfreda","sequence":"additional","affiliation":[{"name":"Nephrology, Royal Cornwall Hospitals NHS Trust, Truro, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zain","family":"Ul Abideen","sequence":"additional","affiliation":[{"name":"Nephrology, Royal Cornwall Hospitals NHS Trust, Truro, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,1,8]]},"reference":[{"key":"2025082700052503000_14.1.e238210.1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m606"},{"key":"2025082700052503000_14.1.e238210.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2020.07.008"},{"key":"2025082700052503000_14.1.e238210.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2020.07.023"},{"key":"2025082700052503000_14.1.e238210.4","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-200969050-00007"},{"key":"2025082700052503000_14.1.e238210.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30628-0"},{"key":"2025082700052503000_14.1.e238210.6","unstructured":"Evaluation of the efficacy and safety of Sarilumab in hospitalized patients with COVID-19. Available: https:\/\/clinicaltrialsgov\/ct2\/show\/study\/NCT04315298 [Accessed 22 Apr 2020]."},{"key":"2025082700052503000_14.1.e238210.7","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1182\/blood.2020006216","article-title":"Tocilizumab not associated with increased infection risk after CAR T-cell therapy: implications for COVID-19?","volume":"136","author":"Frigault","year":"2020","journal-title":"Blood"},{"key":"2025082700052503000_14.1.e238210.8","unstructured":"The RECOVERY trial Study Group. Available: https:\/\/www.recoverytrial.net\/ [Accessed 22 Apr 2020]."},{"key":"2025082700052503000_14.1.e238210.9","unstructured":"The COVACTA trial study group . Study to evaluate the safety and efficacy of tocilizumab in patients with severe COVID-19 pneumonia (COVACTA). Available: https:\/\/clinicaltrialsgov\/ct2\/show\/NCT04320615 [Accessed 22 Apr 2020]."},{"key":"2025082700052503000_14.1.e238210.10","doi-asserted-by":"crossref","DOI":"10.1016\/S2665-9913(20)30313-1","article-title":"COVACTA trial raises questions about tocilizumab's benefit in COVID-19","volume":"2","author":"Furlow","year":"2020","journal-title":"Lancet Rheumatol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-238210","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T07:05:36Z","timestamp":1756278336000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-238210"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1]]},"references-count":10,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,1,8]]},"published-print":{"date-parts":[[2021,1]]}},"alternative-id":["10.1136\/bcr-2020-238210"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-238210","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,1]]}}}