%0 Journal Article
%@ 2590-1702
%A Nguyen, H
%A Salkeld, J
%A Agarwal, S
%A Goodman, A
%D 2021
%F discovery:10184141
%I Elsevier BV
%J Clinical Infection in Practice
%K Agammaglobulinemia, COVID-19, REGN-COV2, Remdesivir, SARS-CoV2
%T Compassionate use of REGN-COV2 in the treatment of COVID-19 in a patient with impaired humoral immunity
%U https://discovery.ucl.ac.uk/id/eprint/10184141/
%V 12
%X 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.
%Z © 2021 The Author(s). Published by Elsevier Ltd on behalf of British Infection Association. This is an open access article under the CC BY-NC-ND.