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The case reported by Guilpain et al attracted our attention. This case of granulomatosis with polyangiitis on immunosuppressants, including recent maintenance therapy with rituximab (RTX), developed a severe and life-threatening coronavirus-2 (SARS-CoV-2) disease 2019 (COVID-19). The particularity of this observation was the occurrence of a more progressive worsening than observed in most series.1 Herein, we report the observation of three patients with systemic sclerosis (SSc) routinely treated with RTX who were affected by COVID-19 and who also experienced a late clinical worsening to severe pneumonia. RTX is often used off-label in patients with SSc mainly for refractory skin, musculoskeletal or interstitial lung disease. Observational studies reported a safety profile similar to that reported in rheumatoid arthritis.2
Their main disease characteristics are presented in table 1. Patient 1 had early diffuse cutaneous SSc, with positive RNA polymerase-3 antibodies, and severe cutaneous involvement (peak modified Rodnan Skin Score at 32/51) as the main clinical involvement. Patient 2 had long-lasting limited cutaneous SSc with recurrent digital ulcers and inflammatory arthritis as the main disease manifestations. Patient 3 had a limited cutaneous subset evolving from 2 years, with positive RNA polymerase-3 antibodies and persisting arthritis. None of these patients had interstitial lung disease and primary or secondary heart involvement. Regarding the main comorbidities, patient 1 was treated for high blood pressure by perindopril, furosemide and lercanidipine, and patient 2 had chronic renal insufficiency and history …
Contributors All authors have contributed to this manuscript and fulfil the requirements for authorship.
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 JA reports personal fees from Sanofi, Abbvie, Boerhinger, Nordic, Novartis, and grants and personal fees from Bristol Myers Squibb, Pfizer outside the submitted work; PA and NC have nothing to disclose. MM-C reports grant and personal fees from Actelion, Biogen, Bayer, Boehringer Ingelheim, CSL Behring and Eli-Lilly, outside the submitted work. YA reports personal fees from Actelion, Bayer, BMS, Boehringer Ingelheim and Curzion, and grants and personal fees from Inventiva, Roche and Sanofi.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; internally peer reviewed.