On final CT check out images (C, F) four days after treatment, total deal with is identified. Discussion Adalimumab was shown to be an effective treatment for the management of individuals with COVID-19 disease. the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 source centre remains active. This article has been cited by additional content articles in PMC. Several hypotheses and evidence suggest the part of immune system overactivity, including cytokine launch syndrome, in the severity of indications, symptoms, and multiorgan failure processes in individuals with coronavirus disease 2019 (COVID-19).1 , 2 Studies possess concluded that the elevation of TNF- may be associated with severe instances of COVID-19.3 TNF- D-glutamine inhibitors have shown to be effective in avoiding lung injury in animal models.4 Therefore, blocking TNF- may play a reasonable intervening part in COVID-19 disease modification. Here the authors report a case of a 50-year-old male patient undergoing coronary artery bypass graft (CABG) surgery, with confirmed COVID-19 pneumonia, who successfully was treated with adalimumab. The control chest computed tomography (CT) scan also exposed radiologically improved lungs without any complications. Case Statement A patient with acute myocardial infarction (fewer than 24 hours) was admitted to the authors division on July 19, 2020. He had been a smoker for the last 15 years, and no extraordinary medical history was recorded. After he underwent coronary angiography, it was revealed that he had three-vessel disease. Therefore, the patient was considered a candidate for CABG surgery. The surgery was carried out on July 20, 2020. During the surgery, the posterior descending artery was grafted with the saphenous vein, and the remaining anterior descending S1PR4 artery was bypassed with the remaining internal mammary artery. The remaining ventricular ejection portion (LVEF) was 55% before the surgery. The real-time polymerase chain reaction (RT-PCR), immunoglobulin M, and immunoglobulin G for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were negative, and the chest x-ray (CXR) and CT scan exposed no abnormal findings before the surgery. The surgery was successful, and the patient did not get any blood products. The ejection portion after the process was 50%. In the first 24 hours after CABG, the CXR still was normal, and the patient was alert D-glutamine and oriented. However, by the second day aftersurgery, the patient complained of shortness of breath, dyspnea, and dizziness, which were not revised with O2 administration. The patient formulated fever (39.1C) and leukocytosis. Meropenem, 1 g TDS , and vancomycin, 1 g BD, were administered for the patient as empiric therapy. Due to the COVID-19 pandemic, he also received hydroxychloroquine, 200 mg BD, and lopinavir/ritonavir (200/50 mg) two tablets BD, based on Iranian national COVID-19 recommendations. On the third day, the patient experienced cardiac arrest. Luckily, cardiopulmonary resuscitation (CPR) was successful, and the patient underwent mechanical air flow. Following the stability of the patient, chest CT imaging exposed massive involvement of the lungs. The second RT-PCR for SARS-CoV-2 confirmed COVID-19 pneumonia in the patient. D-glutamine Based on the comment published in terms of the necessity of conducting tests evaluating the beneficial effects of anti-TNF- therapy in COVID-19,5 adalimumab (CinnoRA, CinnaGen, Iran), a fully human being monoclonal anti-TNF- antibody, was given subcutaneously to the patient on the second day time of intubation (third day time postsurgery) at 40 mg. Moreover, the patient received standard of care, including oxygen and fluid support, 40 mg of pantoprazole daily for stress ulcer prophylaxis, and 40 mg of enoxaparin daily for deep D-glutamine vein thrombosis (DVT) prophylaxis. Meropenem and vancomycin were discontinued. On the fourth day time after intubation (fifth day after surgery), the patient was extubated with stable vital indications. The control CT scan on the same day time of extubation (after stabilizing) exposed radiologically improved lungs. The O2 saturation was increased to 96% from 88%. Respiratory rate was decreased from.