Pulse Therapy with Corticosteroids and Intravenous Immunoglobulin in the Management of Severe COVID-19. Unusual Treatment with Intriguing Results

Multiple data suggest that the aberrant and hyperactive host immune response contributes to severe life-threatening course of Coronavirus Disease 2019 (COVID-19). Specific mechanisms of this influence require further elucidation. The concept of the cytokine release syndrome (“cytokine storm”) is widely discussed and clinically relevant but is being questioned as the levels of specific cytokines in severe COVID-19 vary greatly and usually do not reach the levels seen in other known “cytokine storm” syndromes. Some cases of life-threatening COVID-19 seem “cold” from the point of view of systemic hyperinflammation. Some specific interleukin antagonists were reported to be effective in severe COVID-19. However, their success in this illness is not inevitable. The overall effect of interleukin antagonists on immune defense system in the setting of acute infectious disease is not fully clear yet. Furthermore, newer immunosuppressive drugs are relatively expensive and can become a significant burden for healthcare systems in a large-scale epidemic. Inexpensive immunosuppressive drugs with multiple mechanisms of action can be of value in the treatment of severe life-threatening forms of COVID-19. Corticosteroids and intravenous immunoglobulin can be the natural choice. However, the fear of side effects, especially such as antiviral defense failure and prolonged viral shedding, prevent their wide use in COVID-19. We report three clinical cases of patients with severe life-threatening COVID-19 who failed to achieve substantial improvement on previous treatment and received puls