Acute Ischaemic Stroke in a COVID-19 Patient on Baricitinib - A Causal Effect or a Multifactorial Relationship?

Coronavirus disease 2019 (COVID-19), a multisystemic disorder caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been associated with both venous and arterial thromboses. The hypercoagulable state of the disease poses a challenge to the patient’s management. We herein report a case of acute ischaemic stroke in a COVID-19 patient who had been treated with three days of Baricitinib, an immunotherapy that can potentially augment the thrombotic risks. The case highlights the dilemma faced when initiating immunotherapy in a COVID-19 patient and emphasises the importance of evaluating the patient’s thrombotic risks, balanced against the benefit of immunotherapy, to facilitate the selection of ideal candidates for the immunotherapy.