Unexpected positive effects of rituximab and corticosteroids on COVID-19 in a patient suffering from granulomatosis with polyangiitis

Document Type : CASE REPORT

Authors

1 Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences; Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

The COVID-19 pandemic has raised concerns among physicians and patients with autoimmune disorders about how this viral infection affects the patients receiving immunosuppressive drugs. There are speculations about a higher incidence and severity of COVID-19 in patients receiving a variety of immunosuppressant drugs. However, we reported the rapid recovery from COVID-19 in a 67-year-old male with granulomatosis with polyangiitis who did not experience severe symptoms of the COVID-19 as expected, despite having a history of serious lung involvement due to the autoimmune disease. He received conventional medications to treat COVID-19, though he had been receiving rituximab and corticosteroids before the onset of COVID-19 symptoms. Prevention of the cytokine storm caused by SARS-CoV-2 infection owing to taking the immunosuppressive drugs (rituximab and corticosteroids) could be a reason for these unexpected observations. Therefore, this case showed that taking immunosuppressive drugs is unlikely to be directly related to the increased severity of COVID-19.

Keywords

1.
Lynch JP 3rd, Derhovanessian A, Tazelaar H, Belperio JA. Granulomatosis with polyangiitis (Wegener's granulomatosis): Evolving concepts in treatment. Semin Respir Crit Care Med 2018;39:434-58.  Back to cited text no. 1
    
2.
Kubaisi B, Abu Samra K, Foster CS. Granulomatosis with polyangiitis (Wegener's disease): An updated review of ocular disease manifestations. Intractable Rare Dis Res 2016;5:61-9.  Back to cited text no. 2
    
3.
Pescovitz MD. Rituximab, an anti-cd20 monoclonal antibody: History and mechanism of action. Am J Transplant 2006;6:859-66.  Back to cited text no. 3
    
4.
Kelesidis T, Daikos G, Boumpas D, Tsiodras S. Does rituximab increase the incidence of infectious complications? A narrative review. Int J Infect Dis 2011;15:e2-16.  Back to cited text no. 4
    
5.
Youssef J, Novosad SA, Winthrop KL. Infection risk and safety of corticosteroid use. Rheum Dis Clin North Am 2016;42:157-76.157-x.  Back to cited text no. 5
    
6.
Sohrabi C, Alsafi Z, O'Neill N, Khan M, Kerwan A, Al-Jabir A, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg 2020;76:71-6.  Back to cited text no. 6
    
7.
Monti S, Balduzzi S, Delvino P, Bellis E, Quadrelli VS, Montecucco C. Clinical course of COVID-19 in a series of patients with chronic arthritis treated with immunosuppressive targeted therapies. Ann Rheum Dis 2020;79:667-8.  Back to cited text no. 7
    
8.
Mehra MR, Desai SS, Kuy S, Henry TD, Patel AN. Cardiovascular disease, drug therapy, and mortality in Covid-19. N Engl J Med 2020;382:e102.  Back to cited text no. 8
    
9.
Guilpain P, Le Bihan C, Foulongne V, Taourel P, Pansu N, Maria AT, et al. Rituximab for granulomatosis with polyangiitis in the pandemic of covid-19: Lessons from a case with severe pneumonia. Ann Rheum Dis 2020; 80:e10.  Back to cited text no. 9
    
10.
Tisoncik JR, Korth MJ, Simmons CP, Farrar J, Martin TR, Katze MG. Into the eye of the cytokine storm. Microbiol Mol Biol Rev 2012;76:16-32.  Back to cited text no. 10
    
11.
Soy M, Keser G, Atagündüz P, Tabak F, Atagündüz I, Kayhan S. Cytokine storm in COVID-19: Pathogenesis and overview of anti-inflammatory agents used in treatment. Clin Rheumatol 2020;39:2085-94.  Back to cited text no. 11
    
12.
Zhang JM, An J. Cytokines, inflammation, and pain. Int Anesthesiol Clin 2007;45:27-37.  Back to cited text no. 12
    
13.
Stroopinsky D, Katz T, Rowe JM, Melamed D, Avivi I. Rituximab-induced direct inhibition of T-cell activation. Cancer Immunol Immunother 2012;61:1233-41.  Back to cited text no. 13
    
14.
Djaldetti M. Leibovitch C, Cohen EG, Bessler H. Rituximab modifies peripheral blood mononuclear cells immune responses. Int J Immunol Immunother 2019;6:37.  Back to cited text no. 14
    
15.
Hasan E, Olusi S, Al-Awadhi A, Mokaddem K, Sharma P, George S. Effects of rituximab treatment on the serum concentrations of Vitamin D and interleukins 2, 6, 7, and 10 in patients with rheumatoid arthritis. Biologics 2012;6:31-5.  Back to cited text no. 15
    
16.
Barnes PJ. How corticosteroids control inflammation: Quintiles Prize Lecture 2005. Br J Pharmacol 2006;148:245-54.  Back to cited text no. 16
    
17.
Meduri GU, Headley S, Tolley E, Shelby M, Stentz F, Postlethwaite A. Plasma and BAL cytokine response to corticosteroid rescue treatment in late ARDS. Chest 1995;108:1315-25.  Back to cited text no. 17
    
18.
Wu HP, Shih CC, Chuang DY, Chen TH. Low-dose steroid therapy is associated with decreased IL-12 production in PBMCs of severe septic patients. Mediators Inflamm 2016;2016:1796094.  Back to cited text no. 18
    
19.
Okada Y, Shinohara M, Kobayashi T, Inoue Y, Tomomasa T, Kobayashi T, et al. Effect of corticosteroids in addition to intravenous gamma globulin therapy on serum cytokine levels in the acute phase of Kawasaki disease in children. J Pediatr 2003;143:363-7.  Back to cited text no. 19