The use of passive immunization for the treatment of COVID-19 remains experimental and, as such, it should be monitored carefully

The use of passive immunization for the treatment of COVID-19 remains experimental and, as such, it should be monitored carefully. result (Centers for Disease Control and Prevenion, 2021). X-linked agammaglobulinaemia (XLA) is usually a primary humoral immunodeficiency that causes a significant reduction in mature B-cell count and serum immunoglobulin, and lack of recall humoral response to antigens. This case report describes the clinical course of a 28-year-old patient with a history of XLA who was re-admitted to hospital with fever, asthenia and diarrhoea after recent hospitalization for SARS-CoV-2 pneumonia. His past medical history revealed multiple episodes of upper and lower respiratory tract infections before the delayed diagnosis that caused bronchiectasis. Since the diagnosis of XLA, at 6 years of age, he had been on replacement immunoglobulin therapy with 500 mg/kg/4 weeks intravenous immunoglobulin (IVIG). During his previous Harpagide hospital stay, the patient needed low flow oxygen therapy, and received remdesivir (5-day course), dexamethasone 6 mg (10-day course), empirical antibiotic therapy with amikacin (10-day course) and cefotaxime (14-day course), and Harpagide a further dose of IVIG 20 g. He was discharged from hospital after testing unfavorable for SARS-CoV-2 RNA by reverse transcription polymerase chain reaction (RT-PCR) using nasopharyngeal swab, 11 days after the first positive test. Two weeks after hospital discharge, the patient suffered a relapse of high recurrent fever associated with diarrhoea, and was admitted to a COVID-19-free ward after testing unfavorable on SARS-CoV-2 RNA RT-PCR using nasopharyngeal swab. He denied shortness of breath and chest tightness, but he was persistently febrile despite starting empirical antibiotic therapy with ceftriaxone 2 g every 24 h. Antibiotic therapy was Harpagide stopped on day 14 post admission. Blood tests showed elevated C-reactive protein (CRP) (6.72 mg/dL), serum IL-6 (33.5 ng/L) and serum ferritin (1425 g/L); moderate hypertransaminasaemia (aspartate aminotransferase 259 UI/mL, alanine aminotransferase 139 UI/mL); and moderate lymphocytopenia (1060/mm3). On day 6 post admission, he had a positive result on SARS-CoV-2 RNA RT-PCR (viral load: 4,976,000 copies/mL, 313 copies/100,000 copies RNAse P), and was transferred to the Infectious Diseases Unit. Two days later, he underwent chest computed tomography scan which revealed a pattern compatible with viral pneumonia (ground-glass opacities and crazy-paving). To exclude other concomitant causes, he started a diagnostic workup including blood PCR for viral and Harpagide fungal infections, and several blood cultures. All the microbiological enquiries tested negative. The patient remained febrile, with blood assessments showing persistently elevated CRP (up to 7.69 mg/dL) and ferritin (above 1000 g/L) levels. On day 30 post admission, the patient was administered his replacement therapy with IVIG 30 g, and the following day he retested positive on SARS-CoV-2 RNA RT-PCR using sputum (viral load: 7904 copies/mL, 205 copies/100,000 RNAse P) and nasopharyngeal swab (viral load: 1080 copies/mL). On day 31 post admission, he started a 10-day course of remdesivir (200 mg loading dose followed by 100 mg every 24 h). He defervesced after the first dose of remdesivir, and blood tests around the fourth day of remdesivir showed CRP (3.25 mg/dL) and ferritin (527 g/L) reduced by half and lymphocytic count back to the normal range (1930/mm3). On day 38 post admission (day 8 of antiviral therapy), after giving informed consent, he Rabbit polyclonal to ARHGAP21 was administered 1200 mg of casirivimab (REGN10933) and 1200 mg of imdevimab (REGN10987) for compassionate use (Ethical Committee Approval 0003273-U, 29/01/2021) with no side effects. On day 42 post admission, he had a negative result on SARS-CoV-2 RNA RT-PCR using nasopharyngeal swab (quantitative assay showed no detectable viral load), and he was discharged in good clinical condition. Blood tests showed CRP in the normal range (0.80 mg/dL). At follow-up evaluation, 16 days after hospital discharge, the patient tested unfavorable on SARS-CoV-2 RNA RT-PCR using sputum. He remained apyrexial and asymptomatic. CRP (0.43 mg/dL), IL-6 (10.3 ng/L) and ferritin (98 g/L) levels.