Erkut ETÇİOĞLU, Deniz ÇEKİÇ, Kubilay İŞSEVER, Ahmed Cihad GENÇ, Abdülkadir AYDIN, Selcuk YAYLACI

COVID-19 Hastasında Tosilizumab Kullanımı Sonrası Gelişen Karaciğer Toksisitesi

COVID-19 hastalarında mevcut bilgilerle çeşitli tedavi yöntemleri uygulansa da, kanıtlanmış kesin bir tedavisi bulunmamakta ve dünya çapında etkin tedavi arayışı devam etmektedir. COVID-19 patogenezinde inflamatuar fırtınanın yarattığı etkinin alveol ile kan damarları arasındaki gaz değişim disfonksiyonuna neden olduğu, sonrasında pulmoner fibrozis ve organ yetmezliğine yol açtığı gösterilmiştir. İnterlökin-6 (IL-6) bu patogenezde anahtar role sahiptir. Tosilizumab (TCZ), IL-6 reseptör antagonisti olarak işlev gören, rekombinant insan monoklonal antikorudur. Tosilizumab tedavisinin; IL-6’nın anahtar rol oynadığı sitokin fırtınasını ve inflamatuar hücrelerin akciğere infiltrasyonunu önemli ölçüde azalttığına dair çalışmalar mevcuttur. Bu yazıda; ağır seyirli COVID-19 hastalığından dolayı yoğun bakım ünitesinde takip edilen, tosilizumab tedavisi sonrasında gelişen karaciğer toksisitesi olgusu sunulmuştur.

Anahtar Kelimeler:

Tosilizumab, Karaciğer Toksisitesi, COVID-19, SARS-CoV-2

Liver Toxicity After the Use of Tocilizumab in COVID-19 Patient

Although various treatment methods are used with current information in COVID-19 patients, there is no proven cure and the researchs for effective treatment continues worldwide. It has been shown that the effect of the inflammatory storm in the pathogenesis of COVID-19 causes gas exchange dysfunction between the alveoli and blood vessels, which subsequently leads to pulmonary fibrosis and organ failure. Interleukin-6 (IL-6) plays a key role in this pathogenesis. Tocilizumab (TCZ) is a recombinant human monoclonal antibody that acts as an IL-6 receptor antagonist. There are studies on tocilizumab treatment showing that it significantly reduces the cytokine storm in which IL-6 plays an important role and the infiltration of inflammatory cells into the lung. In this article; a case of liver toxicity developed after tocilizumab treatment, who was followed up in the intensive care unit due to severe COVID-19 disease, is presented.

Keywords:

Tocilizumab, Liver Toxicity, COVID-19, SARS-CoV-2,

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