Successful Therapy of Critically Ill Coronavirus Disease-19 Patients with Intravenous Immunoglobulin (IVIg): A Case Series

Introduction: Coronavirus disease-19 (COVID-19) pandemic management strategy needs therapy with proven safety profiles. Intravenous immunoglobulin (IVIg) has been used for decades in various immune disorders and infection. In COVID-19 context IVIg given mainly in severe to critically ill patients. Cases: We report 3 patients treated with IVIg in our hospital. 1) Male, 61 yo, critically ill COVID-19 and type II DM, had worsening of symptoms 8th day after admission and intubated, IVIg was then administered, ventilator use discontinued at the end of IVIg, recovery achieved in 9 days. 2) Female, 62 yo, admitted with moderate COVID-19 and hypertension. After 9 days, develop deterioration into critical disease. Negative swab results achieved in 10 days after IVIg. 3) Male, 37 yo, critically ill COVID-19, hypertension, and obese. IVIg therapy showed improvement in 3 days. Discussion: IVIg may act against hyperinflammatory state found in critical COVID-19. All patients in our case received IVIg dose 0, 5 g/kgBW/day for 5 days. Time of administration before acceleration phase give greatest benefit. No mortality was observed at 28th and 60th days. Our result demonstrated successful therapy with IVIg as found in other studies. Conclusion: IVIg therapy in COVID-19 is increasingly used worldwide. Recent evidence shows improvement of clinical and supporting examination parameters. Underlying mechanism of IVIg in COVID-19 is still unclear. Further studies are needed.