Sars-COV and SARS CoV-2 have some clinical differences (perchè fare questo paragone con la SARS?C’è stato un errore nella trascrizione non era riferito a questo articolo). (testo corretto) SARS-CoV-2 , the Spanish influenza and another pandemic influenza from H1N1 virus, have a similar elements in their symptoms a Cytokine storm. SARS-Cov2 induce a middle infection into the young children but the mortality is more high in to the adult population: this way of infection it isn't a classic way because the child doesn't have a strong immune response, therefore this atypical response remember us the infection of Spanish influenza just known as pandemic spanish influenza; it had an high score of mortality between the 1918 and the 1920, killing million of persons all around the world. Obesity was an important risk factor for the development of severe forms of H1N1, as well as extreme age groups, pregnancy and chronic medical conditions (2). In patients with severe disease, viral clearance was delayed, with a persistent elevation of pro-inflammatory cytokines and associated multiorgan damage despite antiviral therapy2. Furthermore, a lower serum IgG2 level appeared to be associated with a mild severity of disease, especially in pregnant patients. Severe disease and lung pathology were associated with the deposition of immune complexes. Another important aspect in the pathogenesis of SARS-CoV-2 is the cytokine storm6,13. SARS Cov-2 have some similarity in the pathogenesis with other class of viruses that can stimulate immune response regulated by cytokine IL-6, IL-1, IL-88,10,12,13. In the early hours of a viral infection, the cytokines produced by cells infected or coming into contact with viral products are vital in promoting of the innate immune response18 and of infection14,15. On the basis of the similar pathogenetic pathway in the MASs (macrophage activation syndromes)13 where we can find the presence of an altered immune response making by an higher expression of inflammatory cytokine (IL-6,IL-1, IL-18), responsible to generate a respiratory distress, that we can find also in other pathology with altered immune response i.e. rheumatoid arthritis (l’artrite reumatoide causa distress respiratorio?Si, Infatti il Tocilizumab utilizzato da Ascierto è un farmaco contro l’artrite reumatoide (blocca Il-6),poichè l’artrite reumatoide non ha effetti solo a livello articolare ma anche a livello extraarticolare e una delle sedi è l’apparato respiratorio dove un ecceso di Il-6 può essere causa di distress respiratorio , come spiegato in articolo 12 e 19. Abbiamo sbagliato la citazione ed abbiamo aggiunto un ulteriore articolo in bibliografia. Mi scuso per la svista. La referenza 10 non è attinente)12,19. In literature we can find many links between virus and altered immune response, i.e. EBV and sHLH12. On this wake we can speculate that Covid-19 positive patient with high fever and not responsive at paracetamol and with dyspnoea at the fourth day of manifestation of symptoms could start therapy 3x3x3 with cortisone. That patient showed an improvement in ten days from the beginning of the therapy. In literature we note that treatment of sHLH from EBV in early step making an improvement of the treated patient12.