# Two Cases of Lung Abscess and Pleuritis in Severe COVID-19 Patients

## TL;DR

Two severe COVID-19 patients developed rare lung abscesses and pleuritis after treatment with remdesivir, steroids, and tocilizumab.

## Contribution

Highlights the rare but serious risk of bacterial infections in patients treated with tocilizumab for severe COVID-19.

## Key findings

- Two patients on tocilizumab developed lung abscesses and pleuritis.
- Symptoms of bacterial infections were minimal, leading to delayed diagnosis.
- Tocilizumab may increase the risk of severe bacterial complications in COVID-19.

## Abstract

We report two patients who were treated with remdesivir, steroids, and tocilizumab for severe coronavirus disease 2019 (COVID-19) and developed lung abscesses and pleuritis. Although complications due to bacterial infections are often reported in COVID-19 patients, these severe infections are rare. Patients receiving tocilizumab are at a high risk of developing serious bacterial infections, and the diagnosis is often delayed because symptoms such as fever and elevated C-reactive protein levels are often minimal. The possibility of complications owing to severe bacterial infections should be considered when treating patients with severe COVID-19.