Discussion

COVID-19 disease might show different responses to different therapy because of differences in immune system function 5. The previous study strongly supports a relationship between severe COVID-19 mortality and inflammation6. Studies show that 5-10% of Covid-19 patients develop cytokine storm, which can be fatal. Cytokine storm is observed in other conditions such as infections, autoimmune disorders, and hematological malignancies. When a cytokine storm occurs, the balance between pro-inflammatory and anti-inflammatory cytokines is disturbed, causing tissue damage7. Different cytokines are involved in different etiologies. Specific cytokines in covid-19 help differentiate between clinical intensities, mainly TNF-α, IL-1 β, IL-1Ra, IL-6, IL-7, IL-10, and IP-108. TNF-α is a major pro-inflammatory cytokine responsible for inflammation consequences in COVID-199. Thus, TNF-α contributes to the tissue inflammation of COVID-19.
The reintroduction of oxygen may increase oxidative stress, which leads to the enhancement of inflammation10. Thus, treatment could be more effective before patients go on a ventilator. In the present case, our covid-19 patient did not respond to the immunosuppressive or antiviral drugs such as Methylprednisolone and Remdesiver. The patient was treated with infliximab before chose of the ventilator. A rapid disease remission and enhancement of SPO2 were found after administration of infliximab.