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COVID-19 in a patient with systemic sclerosis treated with tocilizumab for SSc-ILD
  1. Carina Mihai,
  2. Rucsandra Dobrota,
  3. Maria Schröder,
  4. Alexandru Garaiman,
  5. Suzana Jordan,
  6. Mike Oliver Becker,
  7. Britta Maurer,
  8. Oliver Distler
  1. Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
  1. Correspondence to Dr Oliver Distler, Department of Rheumatology, University Hospital Zurich, Zurich 8091, Switzerland; oliver.distler{at}

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During the current global outbreak of coronavirus disease 2019 (COVID-19), risk stratification of patients is of utmost importance. Currently, patients >65 years and those with pre-existing medical conditions such as cardiovascular disease, chronic respiratory disease or diabetes mellitus are considered at higher risk for severe disease.1 The Swiss Federal Office of Public Health, like similar authorities around the world, has additionally included patients on immunosuppressants in the high-risk group for developing severe COVID-19.2 However, at this moment we do not have enough evidence either to support or to reject this assumption.

We report the case of a 57-year-old woman with systemic sclerosis (SSc) who developed COVID-19. Comorbidities were insulin-dependent type 2 diabetes mellitus and WHO grade I obesity. The anti-topoisomerase I antibody-positive patient was diagnosed with SSc in 2017. SSc-associated interstitial lung disease (SSc-ILD), with cough and exertion dyspnoea, was the leading organ manifestation, associated with symmetrical, non-erosive polyarthritis, and elevated acute phase reactants. Treatment with the anti-interleukin (IL) 6 receptor blocker tocilizumab, with 8 mg/kg body weight every 4 weeks intravenously, was started, leading to a good control of both arthritis and SSc-ILD, with gradual improvement of musculoskeletal and respiratory symptoms, …

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