COVID-19 in a Patient Treated for Granulomatosis with Polyangiitis: Persistent Viral Shedding with No Cytokine Storm
Pascale Daniel1, Marc Raad2, Rami Waked3, Jacques Choucair3, Moussa Riachy2, Fady Haddad1
1 Department of Internal Medicine and Clinical Immunology, Hotel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
2 Department of Pulmonary and Critical Care Medicine, Hotel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
3 Department of Infectious Diseases, Hotel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
Doi: 10.12890/2020_001922 - European Journal of Case Reports in Internal Medicine - © EFIM 2020
Received: 27/07/2020
Accepted: 04/08/2020
Published: 24/09/2020

How to cite this article: Daniel P, Raad M, Waked R, Choucair J, Riachy M, Haddad F. COVID-19 in a patient treated for granulomatosis with polyangiits: persistent viral shedding with no cytokine storm. EJCRIM 2020;7 doi:10.12890/2020_001922.

Conflicts of Interests: The authors declare there are no competing interests.
This article is licensed under a Commons Attribution Non-Commercial 4.0 License


Introduction: The coronavirus disease COVID-19 is considered a pandemic disease that has developed rapidly all over the world. As of today, it is unclear whether immunosuppression confers an increased risk for pulmonary complications, or conversely, whether it can be a protective factor with respect to a cytokine storm.
Case description: We report the case of a 55-year-old male patient with granulomatosis with polyangiitis treated with rituximab who was infected with COVID-19 pneumonia. To the best of our knowledge, only 1 case has been reported in the literature with similar characteristics. The patient had a non-classic evolution of clinical symptoms with persistent fever and viral shedding, in addition to a negative serology.
Conclusion: This case emphasizes the management and immunity response to COVID-19 pneumonia in such patients. Data are still needed regarding patients who have prolonged B-cell depletion, which may put the patient at a higher risk for reinfection.


  1. Worldometer [Internet]. Coronavirus updates (live): 3,029,746 cases and 209,244 deaths from the COVID-19 virus pandemic. Available from: (accessed 27 April 2020).
  2. Zheng Z, Peng F, Xu B, Zhao J, Liu H, Peng J, et al. Risk factors of critical & mortal COVID-19 cases: a systematic literature review and meta-analysis. J Infect 2020;81:e16–e25.
  3. de Wit E, van Doremalen N, Falzarano D, Munster V. SARS and MERS: recent insights into emerging coronaviruses. Nat Rev Microbiol 2016;14(8):523–534.
  4. D’Antiga L. Coronaviruses and immunosuppressed patients: the facts during the third epidemic. Liver Transpl 2020;26:832–834.
  5. Marco H, Smith RM, Jones RB, Guerry MJ, Catapano F, Burns S, et al. The effect of rituximab therapy on immunoglobulin levels in patients with multisystem autoimmune disease. BMC Musculoskelet Disord 2014;15:178.
  6. Shi Y, Wang Y, Shao C, Huang J, Gan J, Huang X, et al. COVID-19 infection: the perspectives on immune responses. Cell Death Differ 2020;27(5):1451–1454.
  7. Guilpain P, Le Bihan C, Foulongne V, Taourel P, Pansu N, Maria ATJ, et al. Rituximab for granulomatosis with polyangiitis in the pandemic of covid-19: lessons from a case with severe pneumonia. Ann Rheum Dis. Epub 2020 Apr 20. doi: 10.1136/annrheumdis-2020-217549.
  8. 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(5):667–668.
  9. Bouadma L, Lescure FX, Lucet JC, Yazdanpanah Y, Timsit JF. Severe SARS-CoV-2 infections: practical considerations and management strategy for intensivists. Intensive Care Med 2020;46(4):579–582.