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The novel severe acute respiratory syndrome coronavirus (SARS-CoV-2), causing of coronavirus disease 2019 (COVID-19), is resulting in a worldwide pandemic and has affected more than 200 countries, leading in more than 10 million cases with 508,000 confirmed deaths. The disease spectrum is wide from mild symptoms to severe pneumonia, and some critical conditions be able to produce life-threatening complications, particularly in patients with cytokine release syndrome. This is characterized by dyspnea, hypoxemia and bilateral lung infiltrates on chest radiographic imaging, in case of disease progression invasive mechanical ventilation is needed. The clinical presentation includes hypotension, fever, septic shock with vasopressor therapy, endothelial injury, disseminated intravascular coagulation and multi-organic failure. The most relevant paraclinical parameters associated to cytokine release syndrome are cytopenias, elevated levels of inflammatory cytokines, transaminasemia, coagulation abnormalities and increment in C-reactive protein values. Tocilizumab is a humanized monoclonal antibody against the interleukin-6 receptor (IL-6r), it has been successful administrated in cytokine release syndrome. We propose the blockage with tocilizumab in patients who fulfilled the clinical criteria of cytokine release syndrome based on the literature review as a therapeutic target for COVID-19 infection. [ABSTRACT FROM AUTHOR]

BACKGROUND: The pulmonary changes in COVID-19 are associated with cytokine release syndrome that could be treated with JAK inhibitors through the blockade of type I interferon and IL-6, IL-1, TNF and GM-CSF. CLINICAL CASE: A 32-year-old female with previous iron-deficiency anemia. She presented cough, tachypnea, fever, diarrhea and low oxygen saturation to 86% by pulse oximeter. PCR for SARS-CoV-2 was reported positive and bilateral pneumonia was seen on CT-scan. Diagnosis of COVID-19 pneumonia was confirmed. At diagnosis with erythrocyte sedimentation rate (ESR) 33 mm/hour, CRP 8.4 mg/dL, LDH 317 U/L, DD 412 ng/mL, lymphocytes 0.8 x 10³/μL, hemoglobin 7.4 g/dL with rest of bloodcount being normal. Ruxolitinib at 5 mg BID for 14 days was given. The patient was discharged after 7 days of hospital-length without supplemental oxygen and improvement in CT-scan and proinflammatory values: ESR 18 mm/hour, CPR 0.7 mg/mL, LDH 187 U/L, DD 308 ng/dL, lymphocytes 1.8 x 103/μL, hemoglobin 11.4 g/dL. CONCLUSIONS: Ruxolitinib proved to be a safe and efficient treatment for SARS-CoV-2 pneumonia with limitation of the cytokine release syndrome demonstrated by clinical evolution and proinflammatory markers. [ABSTRACT FROM AUTHOR]