SHM Converge Scientific Abstract ePoster Gallery-Persistent Covid-19 Pneumonia in a Patient on Rituximab

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This case describes a 52-year-old man with CHF, CIDP treated with rituximab, and CKD who was repeatedly hospitalized over two months for fever, night sweats, and cough. Early nasal COVID-19 PCR tests were negative, and one later admission showed only one positive nasal test out of three. He improved briefly after remdesivir and prednisone, but symptoms returned.<br /><br />During his fourth admission, bronchoalveolar lavage (BAL) testing was positive for SARS-CoV-2 and Pseudomonas. Because nasal swabs were negative and he had recently been treated, the BAL result was initially thought to reflect inactive residual viral RNA. However, the BAL cycle threshold of 26 suggested ongoing viral replication. He was then started on Paxlovid, baricitinib, and IVIG, and his fever resolved within two days with rapid clinical improvement.<br /><br />The authors concluded that he had persistent COVID-19 pneumonia likely related to rituximab use four months earlier. Rituximab can suppress B-cell function for 6 to 9 months, weakening antibody-mediated immunity and increasing risk for prolonged viral infections. This case highlights that nasal swabs may miss active lower-respiratory SARS-CoV-2 infection, especially in immunocompromised patients.<br /><br />Key takeaways include the importance of early COVID-19 testing and prompt treatment in patients receiving rituximab, and the potential need for extended antiviral courses such as nirmatrelvir/ritonavir in persistent infection. The report also reviews treatment options for immunocompromised COVID-19 patients, including antivirals, corticosteroids, baricitinib, tocilizumab, IVIG, and convalescent plasma.

Asset Subtitle

Karen A. Clarke

Meta Tag

Author List Claire Wan, Karen A. Clarke, Samuel Stampfer, Sathyabama Naidu

Category Clinical Vignettes

Concept Rituximab

Concept COVID-19 Infection

Concept Persistent COVID-19

Concept B-cell Depleting Therapy

Concept Immunocompromised State

Distinguished Non-Finalist

Presenter Organization Emory University

Presenting Author Karen A. Clarke

Track Adult

Keywords

persistent COVID-19 pneumonia

rituximab

immunocompromised

bronchoalveolar lavage

SARS-CoV-2

nirmatrelvir/ritonavir

baricitinib

intravenous immunoglobulin

negative nasal swab

lower respiratory infection

Rituximab

COVID-19 Infection

Persistent COVID-19

B-cell Depleting Therapy

Immunocompromised State