Immunomodulation with Thymalin in the COVID-19 Re-lated Cytokine Storm: Case Reports

Here we present two patients (the first a 72-year-old male and the second a 69-year-old female) with severe COVID-19 related bilateral pneumonia. In both cases we observed the increased levels of acute-phase reactants and an inflammatory biomarker profile with marked lymphopenia, therefore cytokine storm due to COVID-19 was diagnosed. Both patients were first treated with hydroxychloroquine, cefoperazone/sulbactam, and tocilizumab without any clinical benefit; and was then given thymalin treatment with impressive clinical and laboratory improvement. We performed immunophenotyping of peripheral blood mononuclear cells to assess the dynamics of these cells during COVID-19 related cytokine storm, tocilizumab, and thymalin administration. We observed a decline of CD4+, B-Lymphocytes, and NK-cells after tolicuzimab administration. CD8+ T-cell levels were negatively correlated with inflammatory indicators ESR, CRP, and IL-6.