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Kidney Week

Abstract: PO0156

Intravenous Immunoglobulin: Answer to COVID-19?

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Dabbas, Walaa Said, University of Illinois at Chicago, Chicago, Illinois, United States
  • Naik, Ruchi Harshadrai, University of Illinois at Chicago, Chicago, Illinois, United States
  • Hajjiri, Zahraa F., University of Illinois at Chicago, Chicago, Illinois, United States
  • Ansari, Sajid Q., University of Illinois at Chicago, Chicago, Illinois, United States
Introduction

Traditionally intravenous immunoglobulin (IVIG) has been used for immunodeficiency disorders. It has been also used in certain autoimmune and infectious diseases. IVIG has several immunomodulatory and anti-inflammatory effects. Here, we are reporting a case where IVIG was used for BK viremia in a patient with COVID-19 pneumonia who showed dramatic recovery of COVID-19 symptoms and laboratory parameters.

Case Description

Our patient is a 55-year-old African American male who received simultaneous pancreas and kidney transplant in April 2019 with induction immunosuppression with thymoglobulin and was on chronic immunosuppression with Tacrolimus and Mycophenolic mofetil. His Post-transplant course was complicated by BK viremia and presumed BK nephropathy after 2 months. His immunosuppression was gradually tapered off but his viremia was persistent despite being off Mycophenolate and low target goal of Tacrolimus. Patient partially responded to high dose IVIG so we decided to continue monthly high dose IVIG with daily Leflunomide. Later in April 2021, patient was admitted with COVID-19 symptoms with normal oxygen saturation at room air. His clinical condition worsened over the following 4-5 days in the form of hypoxic respiratory failure requiring high flow oxygen supplements and Acute Kidney injury (AKI) with nephrotic range proteinuria and gradual rising inflammatory markers. Patient was about to be transferred to the Intensive Care Unit as his clinical condition was worsening and refractory to the traditional treatment with steroid and antibiotics. On day 10 he received his monthly due dose of IVIG therapy (0.5 gm/kg of body weight for 4 consecutive days). His COVID symptoms started to improve from day 2 of the treatment. His inflammatory markers were dramatically down trended over the next 3-4 days post IVIG. He was discharged home with oxygen therapy (3L/min) by the day 5 post treatment with IVIG with recovering AKI.

Discussion

Few international studies have reported that initiation of high dose IVIG as adjuvant treatment for COVID-19 disease in selected patients may result in early clinical and laboratory recovery. The studies are limited due to the small sample size and patient selection criteria. Although our patient exhibited dramatic recovery, randomized clinical trial needs to be done to explore more about effect on COVID-19 pneumonia and COVID-19 associated AKI.