Prolonged Course of COVID-19-Associated Pneumonia in a B-Cell Depleted Patient After Rituximab

Abstract

Patients with pre-existing comorbidities and immunosuppression are at greater risk for SARS-CoV-2 infection and severe manifestations of COVID-19. This also includes cancer patients, who are shown to have a poor prognosis after infection. Here, we describe the case of a 72-year old male patient with B-cell depletion after maintenance treatment with rituximab for non-Hodgkin-lymphoma who had a prolonged COVID-19 course and initial false negative test results. Our case highlights the diagnostic pitfalls in diagnosing COVID-19 in B-cell depleted patients and discuss the role of B-cell depletion in the course and treatment of COVID-19. Furthermore, we investigated peripheral blood monocytes and SARS-CoV-2 specific T cells in our patient. In conclusion, our case report can help physicians to avoid diagnostic pitfalls for COVID-19 in hemato-oncological patients under chemoimmunotherapy and tries to explain the role of B-cell depletion and SARS-CoV-2 specific T cells in this context.

COVID-19 in patients with systemic lupus erythematosus: lessons learned from the inflammatory disease

“…Moreover, the effect of B-cell depleting therapy on COVID-19 outcomes needs to be addressed, although very limited data to date suggest the potential for detrimental effects. [148][149][150] Overall, the findings of pathogenic adaptive immune responses in COVID-19 further support the notion that the timely implementation of immunomodulatory therapy in selected patients may be beneficial.…”

“…Moreover, the effect of B-cell depleting therapy on COVID-19 outcomes needs to be addressed, although very limited data to date suggest the potential for detrimental effects. 148 , 149 , 150 …”

Treatment of B-cell depleted COVID-19 patients with convalescent plasma and plasma-based products

“…Immunocompromised patients are prone to develop a prolonged disease course, persistent symptoms, severe manifestations, and decreased viral clearance [ 6 , 7 ]. Herein, we present eight patients with refractory COVID-19, secondary to iatrogenic B-cell depletion.…”

Response to: ‘Antirheumatic drugs, B cell depletion and critical COVID-19: correspondence on ‘Clinical course of coronavirus disease 2019 (COVID-19) in a series of 17 patients with systemic lupus erythematosus under long-term treatment with hydroxychloroquine by Mathianet al’ by Notzet al

“…This process is probably largely involved in cases of a prolonged and/or atypical course of COVID-19 characterised by a negative or delayed serological response against SARS-CoV-2 in B cell depleted patients. [12][13][14][15] It is of note however that many, non-serious, cases of COVID-19 in patients under treatment with RTX have been reported as well. 16 17 Until further studies will help us to understand the risk with respect to COVID-19 severity, treatment with biological diseasemodifying drugs, such as RTX, will have to be applied with particular caution in patients with rheumatic or auto-immune disease, especially if they suffer from other comorbidities which render them particularly at risk.…”