Lack of efficacy during off label use: case reportA 25-year-old man exhibited lack of efficacy during off label treatment with dexamethasone and tocilizumab for COVID-19. The man presented with general malaise, chill, fevers and shortness of breath on exertion. He was diagnosed with COVID-19, and started receiving off label treatment with dexamethasone and tocilizumab [dosages and routes not stated]. However, his condition deteriorated rapidly with respiratory distress (lack of efficacy). Physical examination revealed heart failure, along with low blood pressure. Further investigation revealed elevated troponin, global hypokinesis with 15% ejection fraction and nonischaemic cardiomyopathy, indicating cardiogenic shock.