Progression of COVID-19 in a Patient on Anti-CD20 Antibody Treatment: Case Report and Literature Review

Accumulating evidence suggests that anti-CD20 treatments are associated with a more severe course of COVID-19. We present the case of a 72-year-old woman treated with the B-cell-depleting anti-CD20 antibody rituximab for seropositive rheumatoid arthritis with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causing a clinical relapse more than 4 weeks after the first manifestation. Persistently positive reverse transcription polymerase chain reaction (RT-PCR) results along with a drop in cycling threshold (Ct) values, in addition to recovery of identical viral genotype by whole genome sequencing (WGS) during the disease course, argued against reinfection. No seroconversion was noted, as expected on anti-CD20 treatment. Several other case reports have highlighted potentially fatal courses of COVID-19 associated with B-cell-depleting treatments.