High-dose intravenous immunoglobulin therapy for novel coronavirus disease 2019: a brief report of two cases
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(2020) 12:39
LETTER TO THE EDITOR
Ain-Shams Journal of Anesthesiology
Open Access
High-dose intravenous immunoglobulin therapy for novel coronavirus disease 2019: a brief report of two cases Cem Erdogan1, Bahadir Ciftci1* , Deniz Kizilaslan1, Mursel Ekinci1, Gülsen İptec1, Ali İhsan Gemici2 and Pelin Karaaslan1 To the Editor, Novel coronavirus disease 2019 (2019-nCoV) is a global pandemic which threatens all over the world. The first cases were seen in Wuhan, China, in December 2019 (Guo et al. 2020; Chen et al. 2020). It has spread rapidly, and now, there are more than 2.3 million reported cases and 160,000 deaths worldwide. 2019-nCoV may cause multi-system infections especially respiratory infections such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) (Guo et al. 2020; Chen et al. 2020; Sanders et al. 2020). In some cases, infections may be mild (only cough or fever, etc.); however, in some cases, infections may be severe (acute respiratory failure with diffuse pneumonia). In severe cases, there is an exaggerated immune response with low peripheral lymphocyte levels and high cytokine levels. This mechanism of pathogenesis may be responsible for the multiple organ failures (Cao et al. 2019; Lin et al. 2020). In this early stage of the 2019nCoV, the infection may be treated successfully with immunomodulation (Cao et al. 2019). So, the immunomodulation options like intravenous immunoglobulin should be kept in mind. The intravenous immunoglobulin (IVIg) has been used as a replacement therapy in some immunodeficiency syndromes (Ballow 2008; De Ranieri 2017). IVIg plays an immunomodulatory and anti-inflammatory role in such cases like 2019-nCoV (Cao et al. 2019; Lin et al. 2020). Therefore, IVIg may be used as a supportive immunomodulatory drug as a part of the treatment of 2019-nCoV. We want to share our * Correspondence: [email protected]; [email protected] 1 Department of Anesthesiology and Reanimation, Mega Medipol University Hospital, Istanbul Medipol University, School of Medicine, Bagcilar, 34040 Istanbul, Turkey Full list of author information is available at the end of the article
high-dose IVIg treatment experiences in two 2019-nCoV patients who recovered from the infection in our tertiary university hospital intensive care unit (ICU). Written informed consents were obtained from the patients for this report. The first patient was a 35 years old man. He was diagnosed with 2019-nCoV with specific molecular test (polymerase chain reaction (PCR)) and thorax tomography. He had psoriasis as a comorbidity and received immunosuppressive treatment for 2 years. He was observed in our clinic for 3 days with a 2019nCoV diagnosis. We admitted him to our ICU on the 4th day. He had tachypnea (respiratory rate 45/min) and dyspnea at ICU admission. His peripheral oxygen saturation was 75% with 10 l/min oxygen flow. He had received favipiravir and hydroxychloroquine treatment. In addition, we supported his respiration with non-invasive mechanical ventilation. However, hi
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