Life-threatening secondary infection in a patient with Covid-19 pneumonia treated with tocilizumab: A picture series

As of February 2021, cumulative high-certainty data shows that Tocilizumab decreases the risk of mechanical ventilation in hospitalized patients with Covid-19 [1]. COVID-19 patients receiving tocilizumab may have a theoretical risk of acquiring a secondary infection due to immunosuppression [2]. Here we present a series of chest radiographs of a patient presented with severe Covid pneumonia who improved rapidly with tocilizumab but died of secondary infection later on. A 33 year old male with a history of type 1 diabetes for 8 years was transferred from a local hospital due to desaturation with a history of fever, cough, difficulty in breathing and positive rapid antigen test for Covid-19. On admission, he was tachypneic, tachycardic with a heart rate of 116/min, blood pressure of 125/70 mmHg and pulse oximetry reading was of 90% on air. He deteriorated rapidly over the next few hours requiring intubation and mechanical ventilation. He was continued with intravenous antibiotics, dexamethasone and prophylactic anticoagulation. The first chest x-ray on the day of admission showed widespread consolidation involving all lobes with both lungs with relative sparing of both apical regions (Figure 1). He was treated with Tocilizumab with his rapid deterioration.