Repeated false-negative tests delayed diagnosis of COVID-19 in a case with granulomatosis with polyangiitis under maintenance therapy with rituximab and concomitant influenza pneumonia

Hakroush, Samy; Franz, Jonas; Larsen, Jörg; Korsten, Peter; Winkler, Martin Sebastian; Tampe, Björn

doi:10.1136/annrheumdis-2020-218491

Cited by 8 publications

(5 citation statements)

References 6 publications

(4 reference statements)

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“…These 10 patients were from various case reports and case series. Of these 10 patients, 8 had bilateral pneumonia requiring hospitalization and supplementary oxygen and three died [9,[15][16][17][18][19][20]. All these reports suggest a possible association between rituximab treatment for RMDs and poor prognoses for SARS-CoV-2 infected patients, but no study to date has analyzed the risk of SARS-CoV-2 infection and prognosis of such patients.…”

Section: Discussionmentioning

confidence: 99%

High rates of severe disease and death due to SARS-CoV-2 infection in rheumatic disease patients treated with rituximab: a descriptive study

et al. 2020

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The objective of this study is to describe the characteristics and outcomes of rheumatic and musculoskeletal disease (RMD) patients who were treated with rituximab and had suspected or confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this descriptive study, RMD patients who were treated with rituximab in the last 12 months at the Rheumatology Department of our hospital were screened for SARS-CoV-2 infection via telephone interview and a comprehensive review of clinical health records (01/02/2020-26/05/2020). Those with probable or confirmed SARS-CoV-2 infection were included. In total, 76 patients were screened. Of these, 13 (17.1%) had suspected or confirmed SARS-CoV-2 infection. With regard to these 13 patients, the median age at coronavirus disease (COVID-19) diagnosis was 68 years (range 28-76 years) and 8 (61.5%) were female. Five patients had rheumatoid arthritis, three had systemic vasculitis, two had Sjögren syndrome, and two had systemic lupus erythematosus. Additionally, seven patients (53.8%) had pulmonary involvement secondary to RMD. Eight patients (61.5%) developed severe disease leading to hospitalization, and seven developed bilateral pneumonia and respiratory insufficiency. Of the eight hospitalized patients, five (62.5%) fulfilled the acute respiratory distress syndrome criteria and three developed a critical disease and died. Our cohort had a high rate of severe disease requiring hospitalization (61.5%), with bilateral pneumonia and hyperinflammation leading to a high mortality rate (23.1%). Treatment with rituximab should be considered a possible risk factor for unfavorable outcomes in COVID-19 patients with RMD. However, further study is required to confirm this association.

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Section: Discussionmentioning

confidence: 99%

High rates of severe disease and death due to SARS-CoV-2 infection in rheumatic disease patients treated with rituximab: a descriptive study

et al. 2020

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“…A case of persistent viral shedding with no cytokine storm in a patient with GPA on rituximab has also been reported [ 31 ]. Hakroush et al reported a case of delayed COVID-19 diagnosis in a patient with GPA on rituximab due to repeated negative tests as in the case of our patient, whose diagnosis was finally made by a tracheal aspirate and eventually died [ 32 ]. A long, relapsing, and atypical symptomatic course of COVID-19 in a B-cell-depleted patient after rituximab treatment for GPA has also been reported [ 33 ].…”

Section: Discussionmentioning

confidence: 93%

COVID-19 pneumonia in a patient with granulomatosis with polyangiitis on rituximab: case-based review

et al. 2021

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A 77-year-old man with past medical history of granulomatosis with polyangiitis (GPA) on rituximab and prednisone, presented to the hospital with worsening cough and shortness of breath. He had tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by nasal swab polymerase chain reaction (PCR) while asymptomatic, 6 weeks earlier. He started with cough and shortness of breath 2 weeks after his initial positive test. After developing symptoms, he tested negative twice by nasal swab PCR, but the PCR of his bronchioloalveolar lavage was positive for SARS-CoV-2. He did not develop antibodies against coronavirus. Prednisone 15 mg daily was continued, and he received remdesivir, and convalescent plasma with quick recovery. We reviewed the literature to search for similar cases. Our case suggests that SARS-CoV-2 infection in patients on rituximab may have an atypical presentation and the diagnosis may be delayed due to negative PCR testing in the nasal swab. Patients may benefit from treatment with convalescent plasma.

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“…This report emphasizes the challenges of COVID-19, myocardial involvement, and GPA together in one patient. 12,13…”

Section: Discussionmentioning

confidence: 99%

Acute Myocardial Infarction and COVID-19 in a Known Case of Granulomatosis with Polyangiitis

et al. 2021

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Since the emergence of novel coronavirus and the disease named as COVID-19 in late December of 2019 in Wuhan, Hubei province, China, many aspects of this disease have been reported in the literature (mainly pulmonary manifestations). In patients with COVID-19, rheumatic and cardiovascular manifestations and interactions were reported separately, but they were all very rare. This is the report of a 14-year-old teenager with GPA (previously known as Wegner's granulomatosis) who was in remission with immunosuppressive therapy. Post COVID-19 infection, she developed exacerbation of her disease. Besides the rheumatologic manifestations, she developed epigastric pain found to be acute myocardial infarction (MI) that needed primary percutaneous coronary intervention (PCI).

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Repeated false-negative tests delayed diagnosis of COVID-19 in a case with granulomatosis with polyangiitis under maintenance therapy with rituximab and concomitant influenza pneumonia

Cited by 8 publications

References 6 publications

High rates of severe disease and death due to SARS-CoV-2 infection in rheumatic disease patients treated with rituximab: a descriptive study

High rates of severe disease and death due to SARS-CoV-2 infection in rheumatic disease patients treated with rituximab: a descriptive study

COVID-19 pneumonia in a patient with granulomatosis with polyangiitis on rituximab: case-based review

Acute Myocardial Infarction and COVID-19 in a Known Case of Granulomatosis with Polyangiitis

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