A case of Bundibugyo virus disease treated with monoclonal antibodies and remdesivir.

Clinical data on Bundibugyo virus (BDBV) infection are limited, and no approved virus-specific treatment exists. Here we describe the case of a previously healthy 39-year-old healthcare worker who acquired BDBV infection while working in Ituri Province, Democratic Republic of the Congo, and was medically evacuated to Germany. He received MBP134, an investigational combination of two monoclonal antibodies, under a US Food and Drug Administration (FDA) Emergency Investigational New Drug (eIND) authorization, together with remdesivir and supportive care. Viral RNA concentrations were highest in oropharyngeal swabs and plasma and became undetectable in blood, throat swabs, urine and stool by day 13 after symptom onset and in semen by day 25. The patient's serum demonstrated neutralizing activity against the current BDBV outbreak strain and other orthoebolaviruses. We detected BDBV-induced antibody responses not attributable to MBP134 or prior vaccination, providing evidence of endogenous humoral immunity after combined antiviral treatment. The patient recovered and was discharged on day 22 after symptom onset. This case report provides detailed insights into the clinical course, virologic dynamics and immune responses in BDBV infection during combined antiviral treatment; larger clinical studies are needed to assess the efficacy and clinical utility of these therapeutic approaches.