Intravenous immunoglobulin as a therapeutic option for patients with worsening COVID-19 under rituximab

Vasconcelos, Joana
Portugal, Rita
Torres, Rita
Falcão, Sandra

¹ Infectious Diseases, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
² Internal Medicine, Centro Hospitalar do Médio Tejo EPE, Torres Novas, Portugal
³ Rheumatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal

Correspondence to Dr Joana Vasconcelos; e-mail: [email protected]

Accepted June 03, 2021.

Published Online First June 28, 2021

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.

BMJ Case Reports 14(6c):p e243338, July 2021. | DOI: 10.1136/bcr-2021-243338

SUMMARY

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.