He received ceftriaxone and was prescribed azithromycin

He received ceftriaxone and was prescribed azithromycin. recovery. We reviewed the literature to search for similar cases. Our case suggests that SARS-CoV-2 infection in patients on rituximab may have an atypical presentation and the diagnosis may be delayed due to negative PCR testing in the nasal swab. Patients may benefit from treatment with convalescent plasma. Keywords: COVID-19, SARS-CoV-2, Rituximab, Immunosuppressive treatment, Immunosuppression, B cell depletion, Autoimmune rheumatic disease, Granulomatosis with polyangiitis, GPA, Vasculitis Introduction The extent to which immunosuppressive therapy poses a risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or coronavirus disease-19 (COVID-19) is still debatable [1]. Due to the development of cytokine storm syndrome in severe COVID-19 cases, steroids and certain immunomodulatory and immunosuppressive medications have been postulated to assist in reversal and recovery [2]. The safety of rituximab in patients with COVID-19 is unclear, and controversy exists whether patients treated with rituximab present with less severe or more profound manifestations [3]. Treatment with a monoclonal antibody cocktail or high-titer convalescent plasma may be beneficial in non-hospitalized and hospitalized non-intubated patients, respectively [4, 5]. We present Parbendazole a patient with a past medical history of granulomatosis with polyangiitis (GPA) on prednisone and rituximab, who initially tested positive for COVID-19 while asymptomatic. He later presented with cough and shortness of breath with negative repeat testing for COVID-19, posing a diagnostic dilemma. We conducted an extensive review of the literature for patients with autoimmune rheumatic diseases on rituximab who presented with COVID-19 infection. Our case resembles and mirrors those reporting an atypical and delayed course of COVID-19 infection in patients on rituximab. Case presentation A 77-year-old man with past medical history of GPA on combination therapy with prednisone and rituximab, presented to our Emergency Department (ED) with cough and shortness of breath. The patient had been diagnosed with GPA in 2003 when he presented with pulmonary infiltrates, recurrent uveitis and polyarthralgia. He was initially treated with methotrexate and prednisone which controlled his joint symptoms but not uveitis. Between 2006 and 2015, he received a total of six rituximab treatments administered when he had recurrent uveitis. His GPA went into clinical remission for years and rituximab was discontinued. In the spring of 2020, he presented to his outside rheumatologist with several episodes of transient expressive aphasia and leg weakness and Parbendazole was diagnosed with GPA-related pachymeningitis. He was prescribed levetiracetam and prednisone 40?mg po daily, which led to resolution of leg weakness. His rheumatologist recommended resuming rituximab, but patient Rabbit Polyclonal to CHP2 declined as he was relocating to Arizona. He was subsequently evaluated in our rheumatology clinic in late July 2020. He was feeling well without leg weakness, speech issues, uveitis, nasal or sinus congestion, cough or shortness of breath, or arthralgia. His complete Parbendazole blood count (CBC) with Parbendazole differential and comprehensive metabolic panel (CMP) were within normal limits, erythrocyte sedimentation rate (ESR) was 2, and C-reactive protein (CRP) of??8 (negative??8 (negative?