COVID-19 Poster Presentation

LB1170 - Use of IVIG in three immunosuppressed patients hospitalized with COVID-19 (ID 1673)

Speakers
  • E. Graham
Authors
  • J. Datar
  • C. Bevan
  • E. Graham
  • E. Grebenciucova
  • I. Koralnik
  • B. Cohen
  • R. Balabanov
Presentation Number
LB1170
Presentation Topic
COVID-19

Abstract

Background

The use of intravenous immunoglobulin (IVIG) in patients with severe COVID-19 is currently under investigation. Preliminary data report shorter length of stay and reduced use of mechanical ventilation in patients receiving IVIG. Little is known about the safety and effectiveness of IVIG in an immunosuppressed population with COVID-19.

Objectives

We will describe the use of IVIG in hospitalized patients with neuroinflammatory diseases on chronic immunotherapy presenting with SARS-CoV-2 infection.

Methods

Data was collected prospectively through direct inpatient care as well as follow up via outpatient visits and telephone calls.

Results

We treated three patients admitted to our hospital with IVIG. Patient 1 is a 30-year-old man with antibody-positive neuromyelitis optica (NMO) treated with rituximab 650mg every 3 months with undetectable CD19+ B lymphocytes who presented with multifocal pneumonia and mild hypoxia. His absolute lymphocyte count (ALC) was 600/mm3 on admission. Patient 2 is a 54-year-old woman with CNS vasculitis treated with mycophenolate mofetil 2g daily and one dose of Rituximab 1g five months prior who presented with fever, cough and pneumonia. ALC was 600/mm3. Patient 3 is a 56-year-old woman with antibody-positive NMO, autoimmune hepatitis and autoimmune myositis on mycophenolate mofetil 2.5g daily who presented with hypoxemia requiring high-flow nasal cannula. ALC was 700/mm3. Immunotherapy was held on admission for all patients. They were given 0.4g/kg IVIG (Gammagard) daily for 5 days and prophylactic enoxaparin. IVIG was initiated on days 5, 4 and 3; patients were discharged on days 16, 10 and 17, respectively. The first patient was diagnosed with COVID-19 clinically with later positive antibody testing to SARS-CoV2; the second two were diagnosed via SARS-CoV2 RT-PCR. All patients made a complete recovery without relapse of neuroinflammatory disease.

Conclusions

All three patients had grade II lymphopenia on admission, which is known to be a marker of poor prognosis in COVID-19. None of our patients required intubation nor had side effects from IVIG. The use of IVIG may have prevented relapse provoked by viral illness as well as hastened recovery. Mechanisms of IVIG effect on coronavirus may be governed by sialosides on IgG serving as decoy receptors for the virus or IgG binding to sialosides on the viral surface and preventing viral attachment and fusion. IVIG may prevent an excessive inflammatory response by minimizing the release of pro-inflammatory cytokines and chemokines. Clinicians should carefully consider the risk and benefits when administering IVIG to a patient with SARS-CoV2. Finally, research on how lymphopenia affects outcomes of COVID-19 infection in immunosuppressed patients is warranted.

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