Hedin W, et al. Severe Tick-Borne Encephalitis (TBE) in a Patient with X-Linked Agammaglobulinemia; Treatment with TBE Virus IgG Positive Plasma, Clinical Outcome and T Cell Responses. J Clin Immunol. 2024;44(5):116. doi:10.1007/s10875-024-01718-5

Individuals with X-linked agammaglobulinemia (XLA) have a very low level (<1%) of mature B lymphocytes and are unable to produce immunoglobulins. These patients suffer from recurrent bacterial infections and have an increased risk for viral infections.

Recently, the clinical picture of a 47-year-old patient with XLA who suffered from severe TBE was described and who was treated in the intensive care unit at Karolinska University Hospital, Stockholm, Sweden. On day 2 of admission, the patient received acyclovir, but this treatment was discontinued after negative results for HSV-1 and -2 and VZV and enterovirus diagnosis. Four days after admission, the patient’s condition deteriorated. Despite various treatments, the patient’s status remained critical and on day six, he received intravenous immunoglobulin replacement therapy (IVIG) – 300 ml (100 mg/ml) with intension to help clear the infection, and then, TBE virus IgG positive plasma was given daily for the following five day.

A test for neutralizing TBE antibodies using pre- and post-treatment sera showed seroconversion after IVIG. The patient started to show signs of neurological improvement and was extubated after four days in the ICU. He displayed no adverse effects such as inflammation and allergic reactions. The patient could be discharged five weeks later to a neurological rehabilitation clinic.

The authors concluded that treatment with plasma with detectable levels of TBE virus specific IgG can provide a patient with neutralizing titres and potentially facilitate viral clearance. In this case, no adverse events were observed. This implies that even treatment with monoclonal antibodies might be a future therapeutic option both for prophylaxis and during infection (in this context, have a look at Snapshot week 49/2023).

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