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Case report
Intravenous immunoglobulin as a therapeutic option for patients with worsening COVID-19 under rituximab
  1. Joana Vasconcelos1,
  2. Rita Portugal2,
  3. Rita Torres3 and
  4. Sandra Falcão3
  1. 1Infectious Diseases, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
  2. 2Internal Medicine, Centro Hospitalar do Médio Tejo EPE, Torres Novas, Portugal
  3. 3Rheumatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
  1. Correspondence to Dr Joana Vasconcelos; joanapfvasconcelos{at}hotmail.com

Abstract

Severe cases of the new COVID-19 are being reported in immunosuppressed patients. The risk seems to depend on the type of immunosuppressive agents used and it is particularly important in patients under the long-lasting effect of rituximab. Information regarding the best therapeutic approach to these patients is scarce and further studies are needed. We present a case of a young woman with rheumatoid arthritis treated with rituximab (last administration 4 months before her admission). She presented with a deteriorating and prolonged SARS-CoV-2 infection, with persistent fever, significant elevation of inflammatory markers and radiological progression. Glucocorticoids and antibiotic therapy were initiated, with no response. Intravenous immunoglobulin was then used with a rapid and exuberant response, anticipating a promising role of this therapy in immunosuppressed patients with COVID-19 under the effect of rituximab.

  • COVID-19
  • biological agents
  • rheumatoid arthritis

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/bcr-2021-243338

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    Footnotes

    • Contributors JPFV, RSP and RPT: conception, design and elaboration of the first draft. SF: critical revision. This version was read and approved by all named authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.