Chakraborty Nilanchal, Kumar Hrishikesh
Department of Anesthesiology and Critical Care Medicine, Institute of Neurosciences, Kolkata, West Bengal, India.
Department of Neurology, Institute of Neurosciences, Kolkata, West Bengal, India.
Indian J Crit Care Med. 2020 Dec;24(12):1264-1268. doi: 10.5005/jp-journals-10071-23688.
The 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.
A 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.
Intravenous immunoglobulin can inhibit the production of inflammatory factors and decrease inflammatory injury, multisystem inflammation (MSI) in SARS-CoV-2.
While 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.
Chakraborty 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.
2019年新型冠状病毒病（COVID-19）给公共卫生带来了前所未有的危机，尽管已有几种潜在疗法被临时应用，但尚未达成统一共识。
一名75岁男性，入院时新型冠状病毒病逆转录聚合酶链反应（RT-PCR）呈阳性，表现为急性起病且四肢进行性上行性无力。神经传导速度（NCV）研究提示为急性脱髓鞘和轴索性运动性多神经根神经病。因此，考虑为与COVID-19感染相关的吉兰-巴雷综合征（GBS）。在患病第二周，他的呼吸状况恶化为严重急性呼吸窘迫综合征（ARDS）。开始给予静脉注射免疫球蛋白（IVIg），疗程为5天。入院第10天后，他的呼吸机支持情况开始改善。他的炎症指标开始好转，呼吸机支持逐渐撤减，在患病第17天拔除气管插管。静脉注射免疫球蛋白富含病毒免疫球蛋白G（IgG），能竞争性结合Fcy受体，阻止严重急性呼吸综合征冠状病毒2（SARS-CoV-2）刺突蛋白附着于血管紧张素转换酶2（ACE 2）受体，抑制病毒进入细胞。
静脉注射免疫球蛋白可抑制炎症因子的产生，减轻严重急性呼吸综合征冠状病毒2（SARS-CoV-2）中的炎症损伤和多系统炎症（MSI）。
虽然使用高免疫球蛋白需要从康复且滴度验证合格的患者中进行繁琐的采集工作，但使用静脉注射免疫球蛋白可能是调节免疫风暴及使SARS-CoV-2患者更快康复的更简便选择。
Chakraborty 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.
