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We read with great interest the recent article by Fiedman and Winthrop reporting a patient with granulomatosis with polyangiitis (GPA) being treated with rituximab (RTX), recurrent SARS-CoV-2 disease 2019 (COVID-19) and no detectable SARS-CoV-2 seroresponse after recovery.1 Anti-CD20 therapy impairs humoral response, theoretically increasing the risk of prolonged SARS-CoV-2 infection and shedding as well as subsequent reinfection.1–3 We have recently reported a patient with GPA under maintenance therapy with RTX and SARS-CoV-2 infection.4 Here, we report further details on anti-CD20 therapy with RTX, serological response to SARS-CoV-2 infection, virus elimination and corresponding B cell numbers. This case highlights that B cell numbers in patients with rheumatic diseases treated with RTX could associate with serological response to SARS-CoV-2 infection, which is particularly relevant as RTX may also impair the immunogenicity of SARS-CoV-2 vaccines.
An 80-year-old man had received a diagnosis of GPA in 2014 with biopsy-confirmed renal vasculitis and no history of pulmonary manifestation. After remission induction therapy, he received RTX at a dose of 500 mg every 6 months as maintenance therapy. The last …
Contributors BT conceived the correspondence and wrote the first draft. DT performed urinary SARS-CoV-2 N measurements. PK and MSW provided clinical data. All authors participated in the construction and editing of the manuscript.
Funding BT was supported by the Research program, University Medical Center, University of Göttingen (1403720). The funding sources had no involvement in the design, collection, analysis, interpretation, writing or decision to submit the article.
Competing interests None declared.
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.
Provenance and peer review Not commissioned; internally peer reviewed.