We present the cases of three patients with severe, life-threatening coronavirus disease 2019 (COVID-19) who had failed to achieve substantial improvement on intial treatment. They subsequently received pulse therapy with methylprednisolone [1,000 mg/day intravenously (IV) for three consecutive days] and IV immunoglobulin (20 g/day). This treatment regimen was associated with a prompt resolution of respiratory failure, elimination of clinical manifestations of the cytokine release syndrome (CRS), and reversal of pulmonary CT changes. The treatment was generally safe and well-tolerated. There was no evidence of protracted persistence of the virus in the patients. Further randomized controlled trials are required to better understand the efficacy and safety of high-dose methylprednisolone and IV immunoglobulin, separately or in combination with each other, in the treatment of severe, lifethreatening COVID-19.

Three patients with severe life-threatening COVID-19 who failed to achieve substantial improvement on tocilizumab, received pulse therapy with corticosteroids (methylprednisolone, 1000 mg/day IV for three consecutive days) and intravenous immunoglobulin (20 g/day IV). This was associated with a prompt resolution of respiratory failure, elimination of cytokine release syndrome, and reversal of pulmonary CT changes. The treatment was generally safe and well tolerated. There was no evidence of protracted persistence of the virus in the patients who received pulse therapy. Randomized controlled trials are necessary to specify the efficacy and safety of high-dose methylprednisolone and intravenous immunoglobulin in the treatment of severe life-threatening COVID-19 separately or in combination.