Objective

To report on efficacy and safety of intravenous immunoglobulin (IVIg) therapy in a case series of patients with COVID-19-related encephalopathy.

Methods

We retrospectively collected data on all patients with COVID-19 hospitalized at two Italian hospitals who developed encephalopathy during disease course and were treated with IVIg.

Results

Five patients (two females, mean age 66.8 years) developed encephalopathy after a mean of 12.6 days, since the onset of respiratory/constitutional symptoms related to COVID-19. Four patients suffered severe respiratory distress, three of which required invasive mechanical ventilation. Neurological manifestations included impaired consciousness, agitation, delirium, pyramidal and extrapyramidal signs. EEG demonstrated diffuse slowing in all patients. Brain MRI showed non-specific findings. CSF analysis revealed normal cell count and protein levels. In all subjects, RT-PCR for SARS-CoV-2 in CSF tested negative. IVIg at 0.4 g/kg/die was commenced 29.8 days (mean, range: 19–55 days) after encephalopathy onset, leading to complete electroclinical recovery in all patients, with an initial improvement of neuropsychiatric symptoms observed in 3.4 days (mean, range: 1–10 days). No adverse events related to IVIg were observed.

Conclusions

Our preliminary findings suggest that IVIg may represent a safe and effective treatment for COVID-19-associated encephalopathy. Clinical efficacy may be driven by the anti-inflammatory action of IVIg, associated with its anti-cytokine qualities.

中文翻译：

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静脉注射免疫球蛋白治疗与COVID-19相关的脑病

目的

报告静脉注射免疫球蛋白（IVIg）治疗COVID-19相关性脑病患者的一系列疗效和安全性。

方法

我们回顾性收集了在两家意大利医院住院的所有COVID-19患者的数据，这些患者在疾病过程中发生脑病并接受了IVIg治疗。

结果

自从出现与COVID-19相关的呼吸/体质症状以来，五名患者（两名女性，平均年龄66.8岁）在平均12.6天后出现脑病。四名患者遭受了严重的呼吸窘迫，其中三名需要有创机械通气。神经系统表现包括意识障碍，躁动，del妄，锥体和锥体束外征象。脑电图显示所有患者均弥漫性减慢。脑MRI显示非特异性发现。脑脊液分析显示细胞计数和蛋白质水平正常。在所有受试者中，CSF中SARS-CoV-2的RT-PCR测试均为阴性。脑病发作后29.8天（平均范围：19-55天）开始以0.4 g / kg / die的IVIg剂量，使所有患者完全电临床恢复，并在3中观察到神经精神症状的初步改善。4天（平均，范围：1-10天）。没有观察到与IVIg相关的不良事件。

结论

我们的初步发现表明，IVIg可能代表COVID-19相关性脑病的一种安全有效的治疗方法。IVIg的抗炎作用及其抗细胞因子的质量可能会驱动临床疗效。