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  • Repeated false-negative tests delayed diagnosis of COVID-19 in a case with granulomatosis with polyangiitis under maintenance therapy with rituximab and concomitant influenza pneumonia

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Correspondence
Repeated false-negative tests delayed diagnosis of COVID-19 in a case with granulomatosis with polyangiitis under maintenance therapy with rituximab and concomitant influenza pneumonia
  1. Samy Hakroush1,
  2. Jonas Franz2,
  3. Jörg Larsen3,
  4. Peter Korsten4,
  5. Martin Sebastian Winkler5,
  6. Björn Tampe4
  1. 1 Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
  2. 2 Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
  3. 3 Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
  4. 4 Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
  5. 5 Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center Göttingen, Göttingen, Germany
  1. Correspondence to Dr Björn Tampe, Department of Nephrology and Rheumatology, University Medical Center Göttingen, 37075 Göttingen, Germany; bjoern.tampe{at}med.uni-goettingen.de

https://doi.org/10.1136/annrheumdis-2020-218491

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    In the pandemic of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) disease 2019 (COVID-19), patients with immunosuppressive therapies have a potentially more severe course of the disease. While recent data from the registry of the Global Rheumatology Alliance have been reassuring regarding the use of biological disease-modifying antirheumatic drugs (bDMARDs), no definite recommendations can be made regarding specific bDMARDs.1 In their recent letter, Nuño and coworkers describe a large cohort of 122 patients with rheumatic diseases.2 Most interestingly, higher hospitalisation rates and more severe and life-threatening cases of COVID-19 have been described with the use of rituximab (RTX).2–4 To the best of our knowledge, we here describe the first reported case with repeated false-negative tests and a delayed diagnosis of COVID-19 in a patient with granulomatosis with polyangiitis (GPA) under maintenance therapy with RTX and concomitant influenza pneumonia.

    An 80-year-old man presented to the emergency department with a 2-week history of productive cough. The patient had received a diagnosis of GPA in 2014 with biopsy-confirmed renal vasculitis and no history of pulmonary manifestation. After remission induction, he received RTX at a dose of 500 mg every 6 months as maintenance therapy. A staging CT of the chest 2 weeks prior …

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    Footnotes

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    • Contributors BT conceived the correspondence and wrote the first draft. SH and JF collected pathology specimens and performed histological analysis. JL contributed and interpreted radiology images. PK and MSW provided clinical data. All authors participated in the construction and editing of the manuscript. Compassionate use was approved by our local ethics committee at the University of Göttingen and informed consent for publication was obtained from the patient’s family.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; internally peer reviewed.