Casirivimab-imdevimab monoclonal antibody treatment for an immunocompromised patient with persistent SARS-CoV-2 infection: a case report.

BACKGROUND: Persistent acute SARS-CoV- 2 infection is characterised by the persistence of symptoms of a COVID-19 illness and a persistently positive SARS-CoV-2 RT PCR result. It is often seen in immunocompromised individuals. Currently, there are no approved treatment regimens or guidelines for management. METHODS: Our patient is a middle-aged male who had received chemotherapy prior to the onset of his SARS- CoV-2 infection and subsequently was diagnosed with a persistent and acute SARS- CoV-2 infection after presenting to us with a pyrexia of unknown origin. He was treated on an off-label basis following informed consent with casirivimab-imdevimab monoclonal antibody therapy, comprising two IgG1 neutralising human monoclonal antibodies at a dose of 600 mg each. RESULTS: Our patient had significant clinical improvement on treatment with the monoclonal antibody therapy and it was well tolerated without any adverse effects. He is currently doing well during follow up. CONCLUSIONS: Casirivimab-imdevimab monoclonal antibody therapy could be beneficial for people with persistent acute SARS-CoV-2 infection. Therapy is warranted on a case-to-case basis. This highlights the need to identify immunocompromised individuals who are at risk of developing persistent acute SARS-CoV-2 infection to enable their prompt treatment.

The COVID-19 pandemic was associated with significant mortality and morbidity globally. People with weakened immune systems, such as cancer patients undergoing chemotherapy, are at an increased risk of developing a prolonged course of COVID-19. At present, no effective treatment options are available to treat SARS-CoV-2 infection in such a group of patients. Here, we describe a patient with Hodgkin's lymphoma and papillary carcinoma of the thyroid who went on to develop persistent COVID-19 and made a full recovery following treatment with anti-SARS-CoV-2 monoclonal antibodies. These results highlight the importance of considering similar treatment options for persistent COVID-19 in cancer patients undergoing chemotherapy, upon appropriate clinical evaluation.

Serum Sickness like Reaction Postequine Rabies Immunoglobulins.

A 30-year-old, previously healthy adult male received equine rabies immunoglobulins (Ig) (ERIG) along with anti-rabies vaccinations as per protocol for postexposure prophylaxis after an unprovoked rabid dog bite of grade three wound over the shin of the left lower limb. On the 8th day, he developed urticarial rashes beginning from the site of the wound, which gradually became a widespread maculopapular rash. Development of the rash was followed by low-grade fever, nonspecific arthralgias and soreness in the throat. A diagnosis of serum sickness-like illness was made based on history, temporal correlation of administration of ERIG and development of symptoms. He responded well to antihistaminic and a short course of injectable steroids. The purpose of this article is to increase awareness regarding the clinical presentation and management of this rare yet potentially curable adverse event if identified timely.

Hepatic brucelloma.

The liver is commonly affected in human brucellosis, reflected the effect of Brucella on the RES (reticuloendothelial system) (Akritidis et al. 2007 [1], Sadia Pérez et al. 2001 [2]). The formation of liver abscess (brucelloma) is uncommon (Rovery et al. 2003 [3]). Here we report an interesting case of brucellosis with a liver abscess in a young immmunocompetent individual with no known comorbidities.

Co-existing tuberculosis and malignant mesothelioma with multiple sites venous thrombosis: a case report.

BACKGROUND: Tuberculosis is endemic in India and almost 40 % of the Indian population is infected with tubercle bacilli. Tuberculosis being a great mimicker of infectious as well as non infectious diseases and recent rise of multi drug resistant and extended drug resistant cases have made diagnosis and management more difficult. To the best of our knowledge there have been no reported cases of tuberculosis coexisting with malignant peritoneal mesothelioma leading to multiple site venous thrombosis. CASE PRESENTATION: Forty five year old male, belonging to Indian/Aryan ethnicity presented with cough, breathlessness and fever for 7 months with past history of pulmonary tuberculosis. On examination he was found to have pleural effusion for which he received anti-tuberculosis therapy empirically. Later his condition deteriorated and on further examination he was found to have ascites, multiple site venous thrombosis and pyothorax which was found positive for acid fast bacilli. Despite anti-tuberculosis therapy he did not improve and was suspected to be a multidrug resistant case. Later on computed tomography peritoneal nodule was detected and on biopsy revealed malignant mesothelioma. CONCLUSION: In a diagnosed case of tuberculosis with clinical findings compatible with it but not responding to anti tubercular therapy, underlying secondary co-existing pathology should be explored.

Tubercular pyomyositis in a case of rheumatoid arthritis being treated with infliximab.

A 55-year-old woman with rheumatoid arthritis having 4 months previously received two doses of infliximab, presented with fever, hypotension and swelling of right thigh posterolaterally. CT-guided aspiration was performed from the right thigh and revealed acid-fast bacilli (AFB) +++ and mycobacterial culture grew Mycobacterium tuberculosis. The patient improved on anti-tubercular treatment.

Concomitant gout and rheumatoid arthritis--a case report.

We report a case of definite rheumatoid arthritis and co-existing gout. Although gout and rheumatoid arthritis are relatively common entities individually, the co-existence of these two conditions is rare.