Storm, typhoon, cyclone or hurricane in patients with COVID-19? Beware of the same storm that has a different origin

• DOI: 10.1136/rmdopen-2020-001295
• Publication Date: 2020-05-18T14:18:05Z
• Authors: Alessia Alunno; Francesco Carubbi; Javier Rodríguez-...
• Keywords: Cytokine Storm; Macrophage Activation Syndrome; Toxic shock syndrome; Coronavirus; Pandemic

Some of the articles being published during severe acute respiratory syndrome–coronavirus (SARS-CoV)-2 pandemic highlight a link between forms coronavirus disease 2019 (COVID-19) and so-called cytokine storm, also with increased ferritin levels. However, this scenario is more complex than initially thought due to heterogeneity hyperinflammation. patients develop fully blown secondary haemophagocytic lymphohistiocytosis (sHLH), whereas others, despite consistent release pro-inflammatory cytokines, do not fulfil sHLH criteria but still show some features resembling phenotype hyperferritinemic syndrome. Despite final event (the storm) shared by various conditions leading sHLH, aetiology, either infectious, autoimmune or neoplastic, accounts for differences in phases process. Moreover, evidence hyperinflammatory microenvironment provided rationale employ immunomodulating agents therapeutic purposes COVID-19. This viewpoint aims at discussing pitfalls issues be considered regard use COVID-19, such as timing treatment based on viral load extent cytokine/ferritin overexpression. Furthermore, it encompasses recent findings paediatric field about novel multisystem inflammatory toxic shock syndrome atypical Kawasaki observed children proven SARS-CoV2 infection. Finally, includes arguments favour adding COVID-19 spectrum recently defined ‘hyperferritinemic syndrome’, which already adult-onset Still’s disease, macrophage activation syndrome, septic catastrophic anti-phospholipid