High-Dose Intravenous Immunoglobulin as a Therapeutic Option for Deteriorating Patients With Coronavirus Disease 2019

Cao, Wei; Liu, Xiaosheng; Bai, Tao; Fan, Hongwei; Hong, Ke; Song, Hui; Han, Yang; Lin, Ling; Ruan, Lianguo; Li, Taisheng

Although confirmed cases of COVID-19 have rapidly accumulated during the past 2 months, our understanding of the clinical spectrum and pathophysiological changes of this infection still remains very limited. Nevertheless, no definite treatment has been identified, which makes clinical management extremely difficult. Here we report a case series of patients with COVID-19, all of whom were successfully treated by high-dose IVIg at the early stage of clinical deterioration. Based on these observations, a high dose of IVIg administered at the appropriate point could successfully block the progression of the disease cascade and improve the outcome of COVID-19. The natural history of SARS-CoV-2 infection does not resemble that of any of the previously known coronaviruses. To date, we have noticed quite a wide clinical spectrum of SARS-CoV-2 infection, including asymptomatic infection, mild upper respiratory tract illness, and pulmonary infiltrations. A large proportion of reported symptomatic cases, including our patients and many others, followed a similar track of progression. The infection often started with mild or moderate unspecific symptoms, including but not limited to low-grade fever, sore throat, coughing, fatigue, and malaise, similar to the symptoms of a common cold. The initial symptoms would abate or persist for around 3-7 days, when high-grade fever developed and respiratory distress became quite prominent. Some of these patients would also have gastrointestinal symptoms during this period. However, if we look at the CT series shown here, which were quite typical of most COVID-19 patients, we would have a very strong impression that most of the lesions started from the periphery, especially the subpleural region when acute respiratory distress syndrome (ARDS) developed [5] . These features indicated a hematogenous or lymphatic distribution or spreading of pathogenic factors rather than direct inspiration.