Preliminary results of clinical use of colchicine in COVID-1
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A 37-year-old man working in healthcare was referred to the doctor with severe fatigue and cough for 2?days. Due to his profession, he had contact with hospitalised patients with severe COVID-19. 2 days later his RT-PCR nasopharyngeal swab tested positive. The patient’s reported symptoms were sporadic dry cough, fatigue, low-grade fever (37.5°C), loss of sense of taste and smell, muscle pain, severe eye pain and headache. Oral hydroxychloroquine was prescribed with oral azithromycin for 10 days.

On the sixth day of the course of the disease, the patient showed great improvement of symptoms and on the seventh day the patient showed relapse of the disease with worsening of symptoms, chills and burning sensation in some parts of the body such as knees and calves. On the eighth day of illness, his anti COVID-19 IgG/IgM rapid test showed a positive result for IgM and a negative for the IgG marker. Inflammatory markers such as C reactive protein, ferritin, interleukin-6 (IL6), lactate dehydrogenase (LDH) and fibrinogen were determined during the course of the disease.

Tests performed showed elevated levels of ferritin (709?ng/dL), IL-6 (19.5?pg/mL), fibrinogen (581?mg/dL) and C reactive protein (5301?mg/dL). On 4 May, he underwent chest CT (figure 1) which showed multiple loci of diffuse ground glass opacities with predominance in the pulmonary periphery, more extensive in the posterior regions of the lower lobes exceeding 3.0?cm in length and sometimes perilobular distribution, associated with reticular opacities and septal thickening, and containing areas of denser consolidations. Extension of pulmonary involvement close to 25%.

On day 14 in the disease course, the patient did the tests for the second time and the results showed a further increase in inflammatory markers: ferritin level to 920?ng/dL (29.7% increase from the previous test) and C reactive protein to 7982?mg/dL (50.5% increase from the previous test). Colchicine treatment was started after the exacerbation of symptoms and prescribed for 20 days. On the first day of treatment, the patient took 1?mg of colchicine, followed by 0.5?mg after 1?hour of the first dose.

The following dosage was established in 0.5?mg two times a day for the next 19 days. On 8 May, day 17 of illness, 3?days after the first dose of colchicine, tests were performed again and showed a large decrease in ferritin levels (reduced by 25.9%–681%?ng/dL), LDH (reduced by 6.7%–347?U/L) and C reactive protein (reduced by 85%–1221%?mg/dL). On day 22 of illness, testing showed a further decrease in C reactive protein (0.507?mg/dL) and a significant decrease in IL-6 levels (6.9?pg/mL). All patient-reported symptoms disappeared after 4?days of colchicine use, and the patient had no side effects during treatment. In June 2020, a chest CT was performed again, which showed a positive development of lung recovery.

The reduction in the levels of inflammatory markers was evident after a short period of treatment, and the most important marker analysed, C reactive protein, reduced by about 85% compared with the initial examination, with a progressive improvement in subsequent analyses. There was also a significant difference in symptoms, which improved the course of the disease without requiring hospitalisation.