RESUMEN
Excessive release of interleukin-6 (IL-6) during the progression of coronavirus disease 2019 (COVID-19) induces cytokine storms, resulting in multi-organ damages including liver injury, similar in nature with mechanism of viral hepatitis. Systemic IL-6 has been associated with the incidence of liver injury among COVID-19 patients; however, studies on IL-6 expression in the liver tissue are completely lacking. The aim of this study was to measure the IL-6 expression in the liver tissues and to determine its correlation with the degree of liver injury in fatal COVID-19 patients. Through this first cross-sectional study, IL-6 expression was measured through immunohistochemical staining and the degree of liver injury was identified based on level of serum alanine aminotransferase (ALT). The Spearman correlation test was used to identify the correlation between IL-6 expression and the degree of liver injury. A total of 47 deceased COVID-19 patients were included and IL-6 expression was observed in all post-mortem liver specimens, ranging from mild to strong expression. Liver injury at various degrees (mild to severe) was found in more than half (59.5%) of the cases. The Spearman correlation analysis suggested a statistically insignificant correlation between liver IL-6 expression and the degree of liver injury (r=0.152; p=0.309). In conclusion, even IL-6 expression was observed in all post-mortem liver specimens, there was an insignificant correlation between IL-6 expression in the liver tissue with the degree of liver injury among fatal COVID-19 patients, suggesting that IL-6 was not the only main factor contributing to liver damage in COVID-19 patients.
RESUMEN
Introduction: In COVID-19 patients, Interleukin-6 (IL-6) will increase, and the production of antigens will be excessive, which will cause excessive inflammation of the tissues, especially the respiratory tract, which causes fibrosis in the lungs and can lead to death. Objective: To analyze IL-6 expression of lung tissue in COVID-19 patient severity. Methods: The study is an observational analytic design from July to December 2020. COVID-19 patient severity who died was examined for IL-6 expression on lung tissue. The lung tissue sampling uses the core biopsy method. Results: The total number of samples obtained was 38 samples. Characteristics of patients with a mean age of patients were 48 years, male, the most common chief complaint was shortness of breath, mean symptom onset was 5 days, patient length of stay was 10 days, the most common cause of death was a combination of septic shock and ARDS and the most common comorbid diabetes mellitus. There is an increased WBC, neutrophils, platelets, procalcitonin, CRP, BUN, creatinine serum, AST, ALT, and D-dimer. In this study, the average tissue IL-6 expression was 72.63, with the highest frequency of strong positive 47.4%. Conclusion: An increase in IL-6 expression on lung tissue showed the severity of COVID-19 infection.
RESUMEN
BACKGROUND: Systemic Sclerotic (SSc) with interstitial lung disease (ILD) is a rare autoimmune case. In Indonesia, SSc-ILD cases are still not widely reported. CASE PRESENTATION: A 43-year-old female complained fever, yellow phlegm, and shortness of breath for 1 week. The evaluation results based on the American College of Rheumatology and European League Against Rheumatism (ACR EULAR) classification criteria for systemic sclerosis showed a score of 17. The patient received Methylprednisolone 8 mg tab/8 hours, Meropenem 1 gr/8 hours, Ranitidine 50 mg/12 hours, Metoclopramide 10 mg/8 hours, KSR 600 mg tab/8 hours, Paracetamol 500 mg tab/8 hours, VIP albumin 500 mg tab/8 hours, and Folic acid 400 mg tab/8 hours. The patient underwent high resolution computer tomography (HRCT). A chest scan obtained SSc-ILD. Sputum culture results did not reveal Mycobacterium tuberculosis. DISCUSSION: SSc-ILD patients in endemic tuberculosis need to be examined for GeneXpert and sputum culture. The HRCT scan is more helpful in diagnosing SSc-ILD than bronchoalveolar lavage (BAL). CONCLUSION: The HRCT is one of the gold standards in establishing the diagnosis of SSc-ILD.
