Disbalanced lymphocyte subpopulations are early markers of mortality in our series of 701 SARS‐CoV‐2 infected patients, when severe lymphopenia has yet to develop. If available, the study of lymphocyte subsets by flow cytometry is recommended to identify high‐risk COVID‐19 patients at hospital admission.
In our cohort, abacavir/lamivudine + darunavir/ritonavir was safe, well tolerated and achieved high rates of virological suppression. In a proportion of patients, discontinuation of this effective regimen was possibly due to non-medical reasons.
Background:
Rituximab is a chimeric murine/human monoclonal antibody against CD20. It can be used off label
in autoimmune diseases. Its administration can lead to several types of reactions; infusional immediate reactions and also
delayed reactions like Serum Sickness Reaction (SSR).
Case presentation:
48 years old woman diagnosed with rheumatoid arthritis/systemic lupus erythematosus who developed
refractory immune thrombocytopenic purpura and received treatment with rituximab. After treatment, she developed
erythematous-violet lesions accompanied with fever of 38ºC, dyspnea, joints arthralgia and edema. In the Emergency
Department they observed hypotension, fever, dyspnea, shivering, so intramuscular epinephrine, intravenous corticosteroids,
antibiotics and salbutamol nebulization’s were administered. In our Allergy Unit we performed intradermal test (IDT) with
rituximab (1mg/ml), which was positive at immediate (20min) and late (48h) reading. Attending to the clinical
manifestations and test carried out, she was diagnosed with rituximab SSR. We also studied the molecular mass of the IgEreactive
proteins present in rituximab product by SDS-PAGE Immunoblotting method according to Laemmli, in reducing
and non-reducing conditions, with high sensitivity and using three different polyvinylidene difluoride (PVDF) membrane
blocking substances (skimmed cow's milk, fish collagen and egg white). We did not detect IgE-binding to rituximab
product.
Conclusion:
Pathogenesis of SSR is not well known. The patients after reinfusion can develop immediate reaction
suggesting involved IgE hypersensitivity nevertheless there are patients who tolerated reinfusion. Further studies and assays
are needed to bring greater understanding of this reactions and lead to a safer re-administration if needed.
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