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Background We studied the safety and efficacy of the use of monoclonal antibodies (MAB) against SARS-CoV-2 in pregnant women who developed COVID-19 infection. Methods We conducted a cross-sectional descriptive multi-center study of pregnant patients who developed SARS-CoV-2 infection from January 2021 to January 2022 and received MAB therapy. Primary outcomes assessed were infusion-related adverse events and pregnancy outcomes within one month of MAB infusion. The secondary outcomes assessed were hospitalization and ICU admission for COVID19 infection and thirty-day all-cause mortality. Results 141 patients were included in the study (median age 33 +/- 5.3 SD, median BMI 28.9 +/- 8.42 SD). In terms of COVID vaccination status, 49.6% received one dose, 36.1% were fully vaccinated, and 7% received the booster dose. Most patients received casirivimab/imdevimab (105, 74.5%) followed by sotrovimab (33, 23.4%). Four patients developed adverse reactions to MAB infusion (two grade-2 reactions and two grade-1 reactions as per the National cancer institute infusion reaction grading criteria). Only one patient (0.7%) was hospitalized for COVID-19 infection, however, she was not hypoxic nor required ICU admission. Five patients delivered within four weeks of MAB administration, however, four of those patients were of gestational age > 37 weeks. Data for 30-day all-cause mortality was available on 88.7% (125) of the patients and data for 30-day pregnancy adverse outcomes was available on 86.5% (122) of the patients due to lack of follow-up within the Health System. There was no reported 30-Day all-cause mortality within the cohort. Two patients (1.4%) had premature rupture of the membrane and one patient (0.7%) had premature delivery within 30 days of receiving MAB. Two patients had preeclampsia (1.4%) and one patient (0.7%) was admitted for evaluations of decreased fetal movements. Conclusion Administration of monoclonal antibodies against SARS-CoV-2 was well tolerated during pregnancy. Only 4 out of 141 (2.8%) had mild to moderate infusion-related reactions. The 30-day pregnancy adverse outcomes observed were well below the mean background rate. There was no reported mortality among MAB recipients and only one patient was hospitalized for mild COVID19 infection. Disclosures All Authors: No reported disclosures.

INTRODUCTION: Ulcerative colitis is often characterized by a relapsing and remitting course. Acute flare ups may present as a serious illness. Most patients show a good response to intravenous corticosteroids which is the cornerstone of management of flare ups. However, a number of patients may develop a rapidly progressive illness and will need a colectomy. We present one such case where a colectomy was needed within four weeks of presentation. CASE DESCRIPTION/METHODS: Case report: A 30-year-old female presented to the emergency department for evaluation of high grade fever and abdominal pain associated with vomiting and foul-smelling, non-bloody, diarrhea 5-6 times a day. She had a history of developmental delay with refractory epilepsy but no previous reports of bowel symptoms. Abdominal X-ray showed small bowel obstruction. Further, a dilated colon with intramural edema was seen on CT scan along with an obstruction of distal small bowel. Stool was positive for leukocytes and calprotectin. CRP was elevated. Blood and stool cultures were negative. Three days later, she started having bloody diarrhea. Flexible sigmoidoscopy showed features of chronic severe colitis with ulceration. The tissue was negative for cytomegalovirus. She was diagnosed with inflammatory bowel disease after positive serology and treated with mesalamine and intravenous steroids followed by infliximab infusions with minimal improvement. She developed recurrent bowel obstructions and toxic megacolon for which she underwent a total colectomy with end ileostomy which was life saving for her. DISCUSSION: Acute severe colitis is a medical emergency and despite improvements in medical care, a substantial number of patients fail to achieve remission. Based on the criteria developed by Truelove and Witt, acute severe ulcerative colitis is characterized by the presence of more than 6 bloody stools per day along with any one of the following: tachycardia >90 bpm, fever >37.8 °C, Hb <10.5 gm/dL, and/or ESR >30 mm/h. Nearly 20% of patients end up needing a colectomy during first admission. Intravenous corticosteroids are the mainstay of initial therapy. Response to steroids should be assessed after 3 days. This is indicated by an improvement in symptoms as well as laboratory parameters like CRP, hemoglobin and serum albumin. Partial or non-responders should be considered for alternative therapies. Colectomy is regarded as a lifesaving procedure in those not responding to medical treatment and must be considered as the next therapeutic step.

Introduction Pneumocystis jirovecii is an opportunistic fungal organism that can cause fatal pneumonia in immunocompromised individuals. It is a disease associated with CD4+ T cell depletion or high-dose steroids. However, there is increasing evidence that B cell dysfunction may also play a role in this illness. Case Report A 33-year-old female with SLE, who was maintained on belimumab and low-dose prednisone (2.5 mg daily), presented with progressive cough and shortness of breath. She had been on monthly belimumab and prednisone 2.5 mg daily for 19 months, and her CD4 count was >200/uL, but her CD19+ B cell was <1% due to the belimumab. She developed a persistent cough and progressive dyspnea that did not respond to empiric antibiotic therapy for pneumonia. She went to the hospital for acute worsening of her dyspnea and cough. An extensive workup was performed, including a VATS procedure and surgical biopsy, which gave a definitive diagnosis of PJP. The patient was treated and discharged on trimethoprim-sulfamethoxazole. She made a complete recovery. Discussion Our report demonstrates the first confirmed case of pneumocystis jirovecii pneumonia in a patient with B cell depletion due to chronic maintenance therapy with belimumab. Our patient’s diagnosis of PJP was unexpected, given her normal CD4+ count and the use of such a low dose of prednisone. We attribute her susceptibility to PJP infection to her profound B cell depletion in response to her belimumab therapy, supporting previous research indicating the importance of CD4+ T cells and B cells in the protective immune response against PJP. This case may help shape future clinical guidelines concerning PJP prophylaxis, particularly in SLE patients with deficient B lymphocytic activity and B cell depletion.