High‑dose intravenous immunoglobulins as a therapeutic option in critical illness polyneuropathy accompanying SARS‑CoV‑2 infection: A case‑based review of the literature (Review)

Abstract

The still ongoing COVID-19 pandemic has exposed the medical community to a number of major challenges. A significant number of patients require admission to intensive care unit (ICU) services due to severe respiratory, thrombotic and septic complications and require long-term hospitalization. Neuromuscular weakness is a common complication in critically ill patients who are treated in ICUs and are mechanically ventilated. This complication is frequently caused by critical illness myopathy (CIM) or critical illness polyneuropathy (CIP) and leads to difficulty in weaning from the ventilator. It is thought to represent an important neurologic manifestation of the systemic inflammatory response syndrome (SIRS). COVID-19 infection is known to trigger strong immune dysregulation, with an intense cytokine storm, as a result, the frequency of CIP is expected to be higher in this setting. The mainstay in the diagnosis of this entity beside the high level of clinical awareness is the electrophysiological examination that provides evidence of axonal motor and sensory polyneuropathy. The present article presents the case of a 54-year-old woman with severe COVID 19 infection who developed neuromuscular weakness, which turned out to be secondary to CIP and was treated successfully with a high dose of human intravenous

Characteristics of Developmental and Epileptic Encephalopathy Associated with PACS2 p.Glu209Lys Pathogenic Variant—Our Experience and Systematic Review of the Literature

“…Motor developmental delay and walking difficulties were frequently reported by different authors [ 1 , 7 , 15 , 22 ] without an involvement of the peripheral nervous system [ 30 ]. Some patients presented with a wide-based gait [ 7 , 22 ].…”

COVID‐19 and the peripheral nervous system. A 2‐year review from the pandemic to the vaccine era

“…The majority of patients had received hydroxychloroquine, but no specific treatments were trialed for the concomitant myopathy 183 . Based on prospective case series showing potential benefit of IVIG to prevent disease progression in COVID‐19 184 and on similar experiences with influenza A and B infection, early administration of IVIG has been proposed as a potential preventative intervention for CIM/CI, although evidence is still limited to individual case reports 185 …”

“…184 and on similar experiences with influenza A and B infection, early administration of IVIG has been proposed as a potential preventative intervention for CIM/CI, although evidence is still limited to individual case reports. 185 Prone positioning has been found beneficial in ARDS and successfully translated to the COVID-19 care in the ICU, but it has also posed unexplored challenges. 186 In the setting of PNS disease, entrapment neuropathies have been the most common complication.…”

Efficacy of intravenous immunoglobulin (IVIg) on COVID-19-related neurological disorders over the last 2 years: an up-to-date narrative review

“…Stoian et al ( 2021 ) elucidated for the first time the therapeutic role of IVIg in COVID-19-related critical illness polyneuropathy. The authors dealt with the case of a 54-year-old woman affected by severe pneumonia due to COVID-19, requiring admission to the intensive care unit.…”