Peripheral infiltration of remdesivir in 3 patients with COVID-19: Case series and discussion

The scientists from Netherland reported 3 cases on remdesivir infiltration in patients with Covid-19.

In the first case, a 91-year-old woman experienced remdesivir infiltration resulting in edema, hematoma at the area of infiltration; on palpation, the affected area felt cooler than the surrounding areas. Swelling was still present after 6 weeks. In the second case, remdesivir infiltration occurred in a 72-year-old male, resulting in edema, hematoma, and pain at the area of infiltration. The hematoma lasted for 7 days. The third case concerned a 67-year-old woman, in whom remdesivir infiltration led to edema and a small hematoma. The hematoma regressed to a negligible size within 3 days. However, a week after infiltration, redness had reappeared. In 2 cases, the patient was immediately treated with hyaluronidase injections, but no specific treatments were provided in the other case.

Thae author believe symptoms and signs observed in the 3 cases may have resulted from the low pH (~4) of the nonbuffered remdesivir solution. The possibility of symptoms caused by cyclodextrins in the formulation or by intrinsic toxicity of remdesivir warrants exploration.

van Merendock et al. Peripheral infiltration of remdesivir in 3 patients with COVID-19: Case series and discussion. Am J Health Syst Pharm. 2021 May 5 : zxab197. doi: 10.1093/ajhp/zxab197