Infectious Diseases, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
Internal Medicine, Centro Hospitalar do Médio Tejo EPE, Torres Novas, Portugal.
BMJ Case Rep. 2021 Jun 28;14(6):e243338. doi: 10.1136/bcr-2021-243338.
Severe cases of the new COVID-19 are being reported in immunosuppressed patients. The risk seems to depend on the type of immunosuppressive agents used and it is particularly important in patients under the long-lasting effect of rituximab. Information regarding the best therapeutic approach to these patients is scarce and further studies are needed. We present a case of a young woman with rheumatoid arthritis treated with rituximab (last administration 4 months before her admission). She presented with a deteriorating and prolonged SARS-CoV-2 infection, with persistent fever, significant elevation of inflammatory markers and radiological progression. Glucocorticoids and antibiotic therapy were initiated, with no response. Intravenous immunoglobulin was then used with a rapid and exuberant response, anticipating a promising role of this therapy in immunosuppressed patients with COVID-19 under the effect of rituximab.
有报道称，新出现的 COVID-19 重症病例出现在免疫抑制患者中。这种风险似乎取决于所使用的免疫抑制药物的类型，在长期接受利妥昔单抗治疗的患者中尤为重要。关于这些患者的最佳治疗方法的信息很少，需要进一步研究。我们报告了一例年轻女性类风湿关节炎患者，她接受了利妥昔单抗治疗（最后一次给药是在入院前 4 个月）。她出现了进行性和迁延性 SARS-CoV-2 感染，持续发热，炎症标志物显著升高，影像学进展。开始使用糖皮质激素和抗生素治疗，但没有反应。然后使用静脉注射免疫球蛋白，迅速且明显起效，预示着这种疗法在利妥昔单抗作用下 COVID-19 免疫抑制患者中可能具有良好的疗效。
