• Indian J Crit Care Med · Dec 2020

    Case Reports

    Intravenous Immunoglobulin may Reverse Multisystem Inflammation in COVID-19 Pneumonitis and Guillain-Barré Syndrome.

    • Nilanchal Chakraborty and Hrishikesh Kumar.
    • Department of Anesthesiology and Critical Care Medicine, Institute of Neurosciences, Kolkata, West Bengal, India.
    • Indian J Crit Care Med. 2020 Dec 1; 24 (12): 1264-1268.

    IntroductionThe novel coronavirus disease 2019 (COVID-19) poses an unprecedented crisis for public health, although several potential therapies have been provisionally applied but a unified consensus is yet to be achieved.Case DescriptionA 75-year-old man, COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) positive on admission, presented with acute onset progressively ascending weakness of all four limbs. Nerve conduction velocity (NCV) study suggested acute demyelinating and axonal type of motor polyradiculoneuropathy. Hence, Guillain-Barré syndrome (GBS) related to COVID-19 infection was considered. His respiratory status worsened to severe acute respiratory distress syndrome (ARDS) on the second week of illness. He was started on intravenous immunoglobulin (IVIg) dosed over 5 days. His ventilator support started to improve after the 10th day of admission. His inflammatory markers started to improve, ventilator supports were weaned down and he was extubated on the 17th day of illness. Intravenous immunoglobulin is rich in viral immunoglobulin G (IgG), competitively binds Fcy receptor, preventing SARS-CoV-2 spike protein from attaching to the angiotensin-converting enzyme 2 (ACE 2) receptor, inhibiting viral entry into the cell.Clinical SignificanceIntravenous immunoglobulin can inhibit the production of inflammatory factors and decrease inflammatory injury, multisystem inflammation (MSI) in SARS-CoV-2.ConclusionWhile the use of hyperimmune globulin requires a tedious job of collection from convalescent patients with verified and adequate titers, the use of IVIg could be an easier option to modulate the immune storm and faster recovery in SARS-CoV-2.How To Cite This ArticleChakraborty N, Kumar H. Intravenous Immunoglobulin may Reverse Multisystem Inflammation in COVID-19 Pneumonitis and Guillain-Barré Syndrome. Indian J Crit Care Med 2020;24(12):1264-1268.Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.

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