key: cord-0934921-fn8ohcdj
authors: nan
title: Important lessons from agammaglobulinaemic patient with COVID‐19
date: 2021-04-13
journal: J Paediatr Child Health
DOI: 10.1111/jpc.15488
sha: d834e2a702eafeb44f9497d6ed973ff10626eba0
doc_id: 934921
cord_uid: fn8ohcdj

nan

A 31-year-old man with X-linked agammaglobulinaemia had an unusual illness due to SARS-CoV-2 infection with prolonged, albeit relatively mild pneumonitis and fever for 30 days, which resolved rapidly after remdesivir was commenced. 1 He relapsed 7 days after discharge and responded again to remdesivir; this time he was also treated with convalescent pooled plasma from individuals with SARS-CoV-2 infection and was cured. Presentation and relapse were confirmed genomically to be caused by the same virus. This case is important in showing that remdesivir works. It also suggests that antibody has an important role in supporting SARS-CoV-2 viral clearance and also suggests that antibody may play an immunopathological role in severe COVID-19. In a retrospective study of patients with the related SARS infection, the development of neutralising antibodies early in infection correlated with worse disease outcome. 2 High antibody titres are also associated with severe disease in COVID-19. 3 This agammaglobulinaemic patient's inability to produce SARS-CoV-2 antibodies may explain why he did not progress to adult respiratory distress syndrome or multi-organ involvement, but ironically may also explain his inability to clear the virus and his relapse following cessation of antiviral treatment following the initial illness. The potential role of humoral immunity in causing severe COVID-19, but its necessity in clearing SARS-CoV-2, gives insight into the dynamic interaction between the pathogen and immune system to cause disease that requires further research.

Treatment of COVID-19 with remdesivir in the absence of humoral immunity: A case report

Antibody responses against SARS coronavirus are correlated with disease outcome of infected individuals

Antibody responses to SARS-CoV-2 in patients with novel coronavirus disease 2019