Second COVID-19 infection in a patient with granulomatosis with polyangiitis on rituximab

Friedman, Marcia; Winthrop, Kevin

doi:10.1136/annrheumdis-2021-220088

Cited by 16 publications

(19 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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]. A second COVID-19 infection in a patient with GPA on rituximab has recently been reported [34].…”

Section: Discussionmentioning

confidence: 93%

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

et al. 2021

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 93%

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

et al. 2021

View full text Add to dashboard Cite

show abstract

“…The other patient, also on methotrexate, had his last rituximab infusion, including 50mg prednisolone premedication, 2 weeks before his COVID-19 diagnosis [34]. Another case report from Oregon reviews a patient with granulomatosis with polyangiitis on rituximab with multiple ongoing COVID-19 exposures who acquired SARS-CoV-2 twice [35]. One month after her second infection, COVID-19 IgGfig levels were undetectable [35].…”

Section: Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-cov-2)mentioning

confidence: 99%

Long-Term Safety of Rituximab (Risks of Viral and Opportunistic Infections)

Varley

Winthrop

2021

Curr Rheumatol Rep

View full text Add to dashboard Cite

Purpose of ReviewWe reviewed the current data on infections associated with rituximab use published over the last 5 years. Recent Findings New literature was available on rates of serious infections, Hepatitis B reactivation and screening, and infection with Severe Acute Respiratory Syndrome Coronavirus 2. Summary Rates of infection varied by study and population, however, higher risk of infection in patients with underlying rheumatologic diseases was seen in those who required a therapy switch, had a smoking history, and those undergoing retreatment who had a serious infection with their first course of therapy. With regards to HBV, the proportion of patients screened continues to be inadequate. Despite the upfront cost, HBV screening and prophylaxis were found to be cost effective. There is still limited data regarding COVID-19 severity in the setting of rituximab, however, rituximab, especially in combination with steroids, may lead to more severe disease and higher mortality.

show abstract

“…We read with great interest the recent article by Fiedman and Winthrop reporting a patient with granulomatosis with polyangiitis (GPA) being treated with rituximab (RTX), recurrent SARS-CoV-2 disease 2019 (COVID-19) and no detectable SARS-CoV-2 seroresponse after recovery. 1 Anti-CD20 therapy impairs humoral response, theoretically increasing the risk of prolonged SARS-CoV-2 infection and shedding as well as subsequent reinfection. [1][2][3] We have recently reported a patient with GPA under maintenance therapy with RTX and SARS-CoV-2 infection.…”

mentioning

confidence: 99%

“…1 Anti-CD20 therapy impairs humoral response, theoretically increasing the risk of prolonged SARS-CoV-2 infection and shedding as well as subsequent reinfection. [1][2][3] We have recently reported a patient with GPA under maintenance therapy with RTX and SARS-CoV-2 infection. 4 Here, we report further details on anti-CD20 therapy with RTX, serological response to SARS-CoV-2 infection, virus elimination and corresponding B cell numbers.…”

mentioning

confidence: 99%

Correspondence on ‘Second COVID-19 infection in a patient with granulomatosis with polyangiitis on rituximab’

et al. 2021

View full text Add to dashboard Cite

show abstract

Second COVID-19 infection in a patient with granulomatosis with polyangiitis on rituximab

Cited by 16 publications

References 7 publications

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

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

Long-Term Safety of Rituximab (Risks of Viral and Opportunistic Infections)

Correspondence on ‘Second COVID-19 infection in a patient with granulomatosis with polyangiitis on rituximab’

Contact Info

Product

Resources

About