Favorable outcome of COVID-19 in a young woman with severe Crohn’s disease on regular use of adalimumab and prednisone: a case report

Vechi, Hareton Teixeira; Maia, Lucas Rodrigues; Alves, Manoela do Monte; Rodrigues-Neto, João Firmino

doi:10.1590/S1678-9946202062102

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CASE REPORT • Rev. Inst. Med. trop. S. Paulo 62 • 2020 • https://doi.org/10.1590/S1678-9946202062102 copy

Favorable outcome of COVID-19 in a young woman with severe Crohn’s disease on regular use of adalimumab and prednisone: a case report

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

COVID-19 is a viral disease caused by SARS-CoV-2 that compromises the host immune response in severe cases, promoting a hyperinflammation that results in acute lung injury and multiple organs failure. In this context, patients presenting with immune-related diseases, such as Crohn’s disease, affected by COVID-19, may have an uncertain prognosis. We report on a case of a young female patient with a severe Crohn’s disease that presented with COVID-19 pneumonia and a favorable outcome even maintaining the use of adalimumab, TNF - alpha inhibitor and prednisone. This case raises the hypothesis that aside from prednisone, TNF-α inhibitors such as adalimumab could be used to stop the progression to COVID-19 complications by blocking the TNF-alpha-driven inflammatory process that occurs in severe COVID-19.

COVID-19; Crohn’s disease; TNF inhibitor; SARS-CoV-2

Laboratory Test	Temporal evolution				Reference range

	Apr 2, 2020 (Admission)	Apr 6, 2020	Apr 10, 2020	Apr 15, 2020
Hemoglobin (g/L)	120	119	118	121	125 - 160
White-cell count (per mm³)	5,330	5,600	7,200	7,100	4,500 – 10,000
Differential count (per mm³)
Total neutrophills Total lymphocytes Total monocytes	3,838 1,226 160	2,240 3,136 112	4,608 2,160 144	2,982 3,408 426	2,160 – 6,200 800 – 3,500 120 – 800
Platelet count (per mm³)	137,000	180,000	290,000	219,000	150,000 – 450,000
Alanine aminotransferase (U/L)	35	27	56	22	10 - 39
Aspartate aminotransferase (U/L)	24	39	51	50	10 – 37
Gamma – glutamyl transferase (U/L)	27	ND	ND	ND	5 - 55
Lactate dehydrogenase (U/L)	169	156	456	148	100 – 250
Creatine kinase (U/L)	35	ND	ND	ND	21 – 215
Albumin (g/L)	34	ND	ND	ND	35 – 50
Globulin (g/L)	48	ND	ND	ND	20 – 40
Fecal calprotectin (μg/g)	12	ND	ND	ND	< 50
Blood Urea Nitrogen (mmol/L)	1.55	1.24	1.55	1.63	1.17 – 3.88
Creatinine (μmol/L)	53.9	61.9	55.7	54.8	53.4 – 123.7
Sodium (mEq/L)	138	135	137	135	135 – 145
Potassium (mEq/L)	3.8	3,7	4,8	3,9	3.5 – 5.1
Prothrombine time (sec)	11.7	12.1	11.7	12.5	≤ 14
Activated partial-thromboplastin time (sec)	26	26	26	26	≤ 26
Total bilirubin (μmol/L)	6.8	6.8	ND	8.5	Up to 20.5
Lactate (mmol/L)	2.0	1.9	1.5	2.5	0.5 – 2.2
Fibrinogen (g/L)	1.82	ND	1.82	2.16	1.5 – 4.5
D-dimer (mg/L)	< 100	299	284	296	Up to 400
High-sensitivity cardiac troponin I (pg/mL)	1	ND	ND	ND	Up to 26
Myoglobin (nmol/L)	0.85	ND	ND	ND	< 4
Creatine Kinase – isoenzyme MB mass (μg/L)	12	ND	ND	ND	Up to 25
BNP (pg/mL)	33	ND	ND	ND	< 100
Serum Ferritin (μg/L)	131	142	324	120	6 – 159
High-sensitivity C-reactive protein (mg/L)	42.1	9.4	62.6	4.5	< 5
Erythrocyte sedimentation rate (mm/h)	45	32	ND	ND	Up to 20
Blood gas analysis
pH PaO₂ (mmHg) PaCO₂ (mmHg) HCO₃ (mEq/L) SO2 (%)	7.42 102.3 32.6 20.8 97.4	ND	ND	ND	7.35 – 7.45 80 - 100 35 – 45 22 – 26 95 - 100

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[1] Correspondence to: João Firmino Rodrigues-Neto Universidade Federal do Rio Grande do Norte, Av. Senador Salgado Filho, 3000, CEP 59078-970, Natal, RN, Brazil E-mail:joao_rneto@yahoo.com.br