Disclosures: Deepthi Ganta, MD: No financial relationships or conflicts of interest

Case Diagnosis: 78-year-old female with newly diagnosed Covid Pneumonia

Case Description: 78-year-old female with hypertension, coronary artery disease, and atrial fibrillation admitted to standalone acute inpatient-rehabilitation hospital after right middle-cerebral-artery stroke. Patient’s rehabilitation complicated by new onset of Covid infection with moderate symptoms including cough and fatigue. Chest x-ray showed new infiltrates. Levofloxacin was prescribed for the pneumonia. Casirivimab/Imdevimab(Regeneron) monoclonal antibody (mab) therapy was administered two days after initial symptoms developed.

Setting: Acute Inpatient Standalone Rehabilitation HospitalAssessment/

Results: Patient tolerated MAb treatment infusion well overall with some nausea during infusion only. The next day, patient reported improvement in cough and fatigue. Chest x-ray done five days post infusion showed significant decrease in infiltrates. Patient did not require acute hospital transfer for further treatment.

Discussion: SARS-CoV-2 infects various human cells by its antigen binding to ACE2 receptors. Mab are neutralizing antibodies that bind to SARS-CoV-2 antigen spike, thus preventing interaction of viral protein with ACE2 receptor and leading to virus neutralization. Studies show Mab therapy reduces Covid related hospitalization and death by rapidly decreasing and eliminating viral load. Mab-therapy also has long half-life and provides passive immunity for several months. Treatment most effective when administered within 10 days of onset of symptoms. Covid-19 Mab-therapy currently approved by Food and Drug Association under emergency use authorization for newly diagnosed Covid patients with mild-to-moderate symptoms who are at high risk for progression of disease. These patients include pediatric patients who are 12 years old or older, adults who are 65 years old or older, and individuals who have certain chronic medical conditions. Studies show that Mab-therapy may be associated with worse clinical outcome when administered to patient with severe symptoms requiring oxygenation or ventilation.

Conclusion: This case demonstrates that Mab-therapy is feasible, safe, and effective Covid treatment that should be considered early in acute inpatient standalone rehabilitation hospitals for qualified patients. It allows better outcomes and decrease acute hospital transfers.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2021

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/managing-newly-diagnosed-covid-patient-with-monoclonal-antibody-in-acute-inpatient-standalone-rehabilitation-hospital/