D107-20 IVIG for Rituximab-treated Patients With Prolonged Covid-19: A Case Series
Abstract
COVID-related lung injury arises from viral-mediated tissue destruction and the accompanying host response. Patients treated with rituximab, an anti-CD20 monoclonal antibody that depletes B-cells and impairs humoral immunity, are particularly susceptible to severe and persistent SARS-CoV-2 infection. Rituximab use has been linked to severe COVID-19 disease, prolonged viral shedding, and post-COVID pulmonary complications. Intravenous immunoglobulin (IVIG) has been proposed as an adjunctive therapy for COVID-19, but data in this population remains limited. We present a case series of four rituximab-treated patients with persistent COVID-19 infection who demonstrated clinical improvement after IVIG.
Four adults receiving rituximab for hematologic malignancy or autoimmune disease developed persistent COVID-19 infection. All experienced prolonged or recurrent symptoms, persistent SARS-CoV-2 positivity, and ongoing radiographic evidence of infection or inflammation despite standard therapy. Quantitative immunoglobulins were low in all cases, and transbronchial biopsy in three patients revealed areas of organizing pneumonia (OP). Patient A: A 78-year-old woman with rheumatoid arthritis (RA) on rituximab had recurrent COVID-19 infection resulting in several hospitalizations for hypoxemia. SARS-CoV-2 PCR was repeatedly positive and cross-sectional imaging demonstrated persistent pulmonary opacities. After IVIG, her pulmonary opacities markedly improved and hypoxia resolved. Patient…
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Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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