Abstract
Background
The role of antibodies in coronavirus disease 2019 (COVID-19) in patients with X-linked agammaglobulinaemia (XLA) has yet to be characterised and clinical courses observed in this cohort of patients have been heterogeneous. Whilst some exhibit spontaneous recovery, others have experienced a more protracted disease length. Previous reports have described successful use of convalescent plasma, however there is a paucity of information around the use of the REGN-COV2 antibody cocktail in these patients.
Case report
A patient with XLA was admitted to hospital with COVID-19 and remained persistently symptomatic with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) swab positivity despite treatment with Remdesivir and dexamethasone. Attempts at modulating the immune response with anakinra were unsuccessful. Consent for compassionate use of REGN-COV2 was obtained with administration taking place on day 87 of his illness. This was followed by a period of convalescence and SARS-CoV-2 nasopharyngeal swab negativity. As a consequence of prolonged immunosuppression, the patient developed pneumocystis pneumonia.
Conclusion
This case highlights the role of antibodies in clearing SARS-CoV-2 in a hypogammaglobulinaemic host and demonstrates the consequences of prolonged immunosuppression and delayed treatment. We propose that this may be of particular significance given the capacity of SARS-CoV-2 to develop advantageous mutations in a chronically infected host.
【저자키워드】 COVID-19, SARS-CoV2, Remdesivir, agammaglobulinemia, REGN-CoV2, 【초록키워드】 Dexamethasone, Treatment, coronavirus disease, convalescent plasma, SARS-CoV-2, coronavirus, immune response, Mutation, Pneumonia, antibody, hospital, Immunosuppression, Nasopharyngeal swab, Clinical course, antibody cocktail, symptomatic, Patient, Consent, Swab, information, disease, patients, compassionate use, administration, XLA, acute respiratory syndrome, heterogeneous, negativity, Host, consequence, highlight, X-linked, described, develop, the patient, remained, was obtained, cohort of patient, modulating, with COVID-19, 【제목키워드】 Treatment, Humoral immunity, Patient,