In December 2021, the Omicron variant became the predominant infection in New York. patients account for a vast majority of SARS?CoV?2 deaths. Monoclonal antibodies (mAb) are an important addition to COVID-19 treatment along with oral antiviral agents (OAA) for non-hospitalized patients with risk factors for progression to severe COVID-19 [1].? These antibodies bind to the spike protein of SARS-CoV-2 and prevent its entry and further disease worsening [2]. They are currently approved for use in adult and pediatric patients, who are 12 years old and weigh at least 40 kg, and tested positive for SARS-CoV-2 with risk factors for progression of the disease to severe COVID-19. These are not authorized for hospitalized patients, patients requiring oxygen, or increasing oxygen requirements for those on long-term oxygen therapy. We present a case of a 74-year-old unvaccinated Hispanic woman who survived two episodes of COVID-19 infection with mAbs, despite multiple major risk factors, demonstrating the value of mAb. Resistance to mAb has emerged, with only sotrovimab and bebtelovimab remaining effective against the omicron variant of SARS?CoV?2. Case presentation Our patient is a 74-year-old Hispanic woman who first presented in January 2021 with body aches, headache, loss of smell, change in taste, dry cough, and fever of five-day duration. Her past medical history was significant for diabetes mellitus, hypertension, coronary artery disease, obesity, and asthma. Past surgical history was significant for coronary artery bypass, hysterectomy, and cystocele repair. Her family history was remarkable for hypertension and diabetes. She had no known drug allergies. She denied smoking, alcohol abuse, or use of recreational drugs. She had not received any COVID-19 vaccine. Her nasopharyngeal polymerase chain reaction (PCR) swab was positive for SARS-CoV-2. On physical examination, her temperature was 98.4?Fahrenheit (F), respiratory rate was 16 breaths per minute, Amlodipine a saturation of 97% on room air, pulse rate of 56 beats per minute, and blood pressure of 113/61 mmHg. Her body mass index (BMI) was 35.6 kg/m2. She appeared lethargic on examination and had bilateral crackles on lung auscultation. Cardiac examination revealed normal S1 and S2 heart sounds. Abdominal and neurological examination was unremarkable. She was offered mAb infusion, given her many risk elements for disease development. Her initial lab findings are shown in Desk ?Desk1.1. Her SARS-CoV-2 nucleocapsid antibodies had been nonreactive as recognized by?Elecsys Anti-SARS-CoV-2 check (Roche Diagnostics International Ltd., Rotkreuz, Switzerland). Because the dominant strain was Alpha variant she received and agreed bamlanivimab infusion. She didn’t encounter any relative unwanted effects through the mAb infusion. She reported that fever, body pains, headaches, lack of smell, and modification in taste solved after a day of infusion. Her coughing resolved on the 3rd day following the mAb infusion. Desk 1 Overview of Laboratory Results During Both Clinical EncountersSARS-CoV-2: Severe severe?respiratory symptoms coronavirus Amlodipine 2? Lab InvestigationFirst EncounterSecond EncounterReference RangeWhite Bloodstream Cell Count number (K/ul)4.06.14.8 – 10.8Absolute Lymphocyte Rely (K/ul)2.52.41.0 – 4.8Hemoglobin (g/dl)11.811.512.0 – 16.0Hematocrit HOXA9 (%)36.135.442.0 – 51.0Platelet count number (K/ul)177205150 – 400Serum Sodium? (mEq/l)133136135 – 145Serum Potassium (mEq/l)4.2?4.13.5 – 5.0Serum bicarbonate (mEq/l)312724 – 30Serum Chloride (mEq/l)969898 – 108Blood Urea Nitrogen (mEq/l)9.09.06.0 – 20.0Serum Creatinine (mEq/l)1.01.00.5 – 1.5Lactate Dehydrogenase? (device/L)211371110 – 210C-Reactive Proteins (mg/L) 5.0013.31 5.00D-Dimer (ng/mL) 1501570 – 230Ferritin (ng/mL)101. 077.913-150SARS-CoV-2 nucleocapsid antibodiesNon-reactiveReactiveNon-ReactiveSARS-CoV-2 spike antibodiesNot obtainable22.50 U/mL = 0.00 U/mL Open up in another window Twelve months later, she offered a dried out coughing again, headaches, fever, lack of smell, and change in taste for three times. She denied getting hospitalized or sick because the previous show. She denied getting any vaccination for COVID-19 in the interim. Her nasopharyngeal PCR swab was positive for SARS?CoV?2. At demonstration, her temp was 98.4 F, respiratory price was 15 breaths each and every minute, a saturation of 98% on space air, pulse price of 72 beats each and every minute, and blood circulation pressure of 144/91 mmHg. She got incessant hacking and coughing and made an appearance lethargic on general exam. She got bilateral vesicular deep breathing on lung auscultation. Cardiac exam revealed regular S1 and S2 center noises. Abdominal and neurological exam was unremarkable. Since she got multiple risk elements and worsening symptoms, she was provided mAb infusion. Her lab results are summarized in Desk ?Desk11. Her SARS-CoV-2 nucleocapsid antibodies recognized by?Elecsys Anti-SARS-CoV-2 check (Roche Diagnostics Amlodipine International Ltd., Rotkreuz, Switzerland) had been reactive and her.