COVID-19 in a Patient Treated for Granulomatosis with Polyangiitis: Persistent Viral Shedding with No Cytokine Storm

Pascale Daniel; Marc Raad; Rami Waked; Jacques Choucair; Moussa Riachy; Fady Haddad

doi:10.12890/2020_001922

COVID-19 in a Patient Treated for Granulomatosis with Polyangiitis: Persistent Viral Shedding with No Cytokine Storm

Eur J Case Rep Intern Med. 2020 Sep 24;7(10):001922. doi: 10.12890/2020_001922. eCollection 2020.

Authors

Pascale Daniel¹, Marc Raad², Rami Waked³, Jacques Choucair³, Moussa Riachy², Fady Haddad¹

Affiliations

¹ Department of Internal Medicine and Clinical Immunology, Hotel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon.
² Department of Pulmonary and Critical Care Medicine, Hotel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon.
³ Department of Infectious Diseases, Hotel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon.

Abstract

Introduction: The coronavirus disease COVID-19 is considered a pandemic disease that has developed rapidly all over the world. As of today, it is unclear whether immunosuppression confers an increased risk for pulmonary complications, or conversely, whether it can be a protective factor with respect to a cytokine storm.

Case description: We report the case of a 55-year-old male patient with granulomatosis with polyangiitis treated with rituximab who was infected with COVID-19 pneumonia. To the best of our knowledge, only 1 case has been reported in the literature with similar characteristics. The patient had a non-classic evolution of clinical symptoms with persistent fever and viral shedding, in addition to a negative serology.

Conclusion: This case emphasizes the management and immunity response to COVID-19 pneumonia in such patients. Data are still needed regarding patients who have prolonged B-cell depletion, which may put the patient at a higher risk for reinfection.

Learning points: Demonstration of the immunity response to COVID-19 pneumonia in an immunosuppressed patient.To highlight the management and evolution of such rare cases during this pandemic.

Keywords: COVID-19; SARS-CoV-2; granulomatosis with polyangiitis; rituximab.