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We read with great interest the recent article by Potere et al using interleukin (IL)-6 receptor blockade with subcutaneous tocilizumab in SARS-CoV-2 COVID-19 pneumonia and hyperinflammatory syndrome.1 A potential preventive or therapeutic effect of certain immunomodulatory therapies in COVID-19 has been hypothesised. Among them, corticosteroids, IL-6 or IL-1 antagonists have been reported and successfully used in severe COVID-19 and associated hyperinflammatory syndromes.1–4 The hyperinflammation observed in adult patients with severe COVID-19 resembles a cytokine release syndrome (CRS) associated with CD4+ and CD8+ T-cell lymphopaenia and increased cytokine levels, including IL-6, correlating with clinical severity.5–9 In contrast to CRS, immune reconstitution inflammatory syndrome (IRIS) is an exaggerated inflammatory response driven by predominant CD4+ T helper cells that have been reported secondary to previous initiation of antiretroviral therapy (ART) when the immune system begins to recover following treatment with ART.10 Since ART for COVID-19 is among the leading drug candidates in this pandemic, a clear sense for associated hyperinflammatory syndromes is required.11 We describe here a case of IRIS …
Contributors BT conceived the correspondence, collected and analysed data, and wrote the first draft. PK, CB and MSW participated in the construction and editing of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; internally peer reviewed.