The course and management of coronavirus infection (CI) in patients with severe comorbidity are extremely important scientific and practical issues in the era of COVID-19. Kidney transplant recipients make up one of the most vulnerable groups for CI-associated adverse outcomes. Considering the presence of comorbidities, the optimal pharmacotherapy regimens for CI and its complications have not yet been worked out for these patients. In this article, we present two clinical observations demonstrating typical manifestations of coronavirus pneumonia (CP) in kidney transplant recipients, the COVID-19 diagnostic and verification algorithm, and the therapeutic options used to achieve a favorable outcome of CP and to prevent fatal complications. Our findings confirm that in kidney transplant recipients CP is linked to increased disease severity with rapid progression of lung damage and a high risk of developing systemic complications, including thrombotic microangiopathy. It is shown that compliance with the current recommendations for a rational combination of antiviral, anti-inflammatory, anticoagulant and basic immunosuppressive agents in this group of patients provides good treatment outcomes and prevents kidney transplant failure. Two adverse outcomes in the observed group were due to associated opportunistic infection. Based on our findings and clinical data, we conclude that preemptive therapy with IL-6 inhibitors or colchicine is an effective therapeutic option in kidney transplant recipients.

Background. Rheumatic diseases (RD) of autoimmune origin are considered as an important risk factor for infectious processes due to characteristic native immune system disorder, as well as due to the adverse effect of immunosuppressants and glucocorticoids on the mechanisms of anti-infective protection.Aim. To highlight the problem of RD and concomitant viral infection which becomes critical in the era of COVID‑19.Results. According to the current national guidelines for the management of patients with COVID‑19, patients with RD represent an increased risk group for the adverse course of coronavirus infection. Presented article provides basic information on the use of interleukin‑6 (IL‑6) inhibitors in patients with COVID‑19 focusing on the benefit of this therapeutic option in those with prior RD. The article presents an analysis of two clinical cases demonstrating high efficacy and good tolerability of levilimab (Ilsira®) in the treatment of coronavirus pneumoniae in the setting of autoimmune diseases: polymyositis (PM) and rheumatoid arthritis (RA).Conclusion. Our own clinical experience confirms the feasibility of including an IL‑6 receptor inhibitor in the treatment regimen for coronavirus pneumonia in patients with RD characterized of immune inflammation.

Specialists in rheumatology quite often have to deal with the so-called overlap syndromes, characterized by the phenomenon when the onset of the immune-inflammatory process corresponding to one rheumatic disease later turns to another clinical form or even process. It is well known about the possible transformation of rheumatoid arthritis (RA) into systemic scleroderma, Sjögren's disease, systemic lupus erythematosus (SLE). Along with this, of particular interest is the likelihood of developing an autoimmune process in the setting an autoinflammatory syndrome, which includes adult Still's disease (ASD). The article presents a clinical observation demonstrating the transformation of APS into spondyloarthritis, and then into RA. While there are many reports of the transition from systemic juvenile idiopathic arthritis (sJIA) to seropositive RA, the development of seropositive RA in adults with autoinflammatory syndrome is a very rare clinical situation. The analyzed aspect is of particular importance since the approaches to the management of patients with ASD and RA differ significantly in the range of biological agents used in these diseases. So, if the use of IL-1 inhibitors is recommended for the treatment of APS, then with a confirmed diagnosis of RA, the prospect of using other anticytokine agents, preferably IL-6 inhibitors, opens up. Thus, the observed clinical case is interesting not only from the standpoint of the importance of the precise form of the immune mediated disease identification at the time of choosing the optimal treatment, but also the differentiated use of biological agents, including Russian-made IL-6 inhibitors.