Cytokine Storm

A cytokine storm is a severe medical condition that happens when your immune system makes too many cytokines, and you develop life-threatening inflammation. Cytokines are special proteins that manage your immune system’s response to invaders like bacteria, viruses or cancer cells.

When you’re sick, your immune system releases different types of these special proteins. Some drive inflammation that gets rid of invaders and helps you heal. Others set limits on inflammation.

During a cytokine storm, your immune system makes and releases large numbers of cytokines that drive inflammation. They outnumber those that control inflammation. This situation sets off waves of inflammation that damage your tissues and organs and can cause organ failure.

Symptoms of cytokine storm

One common symptom is a high fever. A high fever in an adult is 103 degrees Fahrenheit (39.4 degrees Celsius). A high fever in a child is 104 degrees F (40 degrees C). You may have a high fever along with symptoms like:

• Cough or issues breathing
• Confusion or hallucinations
• Dizziness or feeling lightheaded
• Fast heartbeat
• Fatigue
• Headaches
• Joint and muscle pain
• Lack of appetite
• Rash
• Severe nausea, vomiting or diarrhea

Your symptoms may vary depending on the underlying condition. Let your provider know if you have new symptoms. The changes may be related to the underlying condition, or they could be an early sign of cytokine storm.

Cytokine storm causes

The most common cause is infectious diseases. But some autoimmune diseases and genetic syndromes may cause this condition.

Infectious disease

COVID-19 is an example of an infectious disease that may trigger a cytokine storm. This can happen when your immune system tries to get rid of the infection by releasing lots of cytokines. Other examples include:

• Bird flu (avian influenza)
• Dengue fever
• Epstein-Barr virus
• MERS
• SARS

Autoimmune diseases

Autoimmune diseases happen when your immune system mistakenly attacks healthy tissue and organs. The constant attacks may trigger a cytokine storm. Diseases that may do that include:

• Lupus
• Still’s disease

Genetic causes

Familial hemophagocytic lymphohistiocytosis (HLH) is an example of an inherited disorder that increases your risk. In HLH, your immune system can’t turn off an inflammatory response to infection.

Complications

Cytokine storms can cause life-threatening complications, like:

• ARDS (Acute respiratory distress syndrome)
• DIC (Disseminated intravascular coagulation)
• MODS (Multiple organ dysfunction syndrome)

How doctors diagnose this condition

A healthcare provider will discuss your symptoms. They’ll ask about your health, specifically if you’re receiving treatment for a condition that can lead to a cytokine storm. They’ll do the following tests:

• Complete blood count (CBC)
• Cytokine panel to check for cytokines that manage inflammation
• C-reactive protein and other tests that check inflammation levels

How is a cytokine storm treated?

Your healthcare team will tailor treatment for your situation. They may use medications, including:

• Corticosteroids: This medication treats inflammation.
• Cytokine inhibitors: You may receive Il-6 or IL-1 inhibitors. IL-6 stands for interleukin-6, a cytokine that promotes inflammation. Medications include tocilizumab (Actemra®), sarilumab (Kevzara®) and siltuximab (Sylvant®) These are all IL-6 medications. A related treatment is anakinra (Kineret®). This is another inflammatory cytokine.
• JAK inhibitors: This includes baricitinib (Olumiant®) and ruxolitinbib (Jakafi®). JAK stands for Janus kinases, a group of proteins that promote inflammation.

When should I seek care?

This condition can cause many symptoms. Some are more serious than others. You should talk to a healthcare provider if you have a high fever, fast heartbeat or severe nausea and vomiting.

What can I expect if I have this condition?

In general, prompt treatment can calm a cytokine storm. But everyone’s situation is different because so many issues can lead to it. If you’re receiving treatment for this condition, ask your healthcare provider how it may affect your health going forward.

What’s the difference between cytokine storms and cytokine release syndrome?

Cytokine release syndrome (CRS), like cytokine storm, happens when your body releases inflammatory cytokines. The difference is that cancer treatment, like immunotherapy, causes CRS. Cytokine storm is a complication of certain infectious diseases and autoimmune disorders.