Severe COVID pneumonia and undetectable B cells after vaccination in patients previously treated with rituximab: a case series

ABSTRACT

Introduction

The risk of developing severe COVID-19 illness despite completing vaccination for patients who have previously received immunosuppressive therapy is unclear.

Case Presentation

We present three patients who received rituximab for treatment of autoimmune disorders who subsequently developed severe COVID-19 pneumonia post-vaccination requiring intensive care unit admission and found to have undetectable B cells.

Discussion

While there have been concerns about the effectiveness of COVID-19 vaccines in this patient cohort, this is the first case series to report development of severe COVID-19 illness after completing vaccination in those who previously received rituximab. Guidelines for the optimal timing of COVID-19 vaccination in relation to immunosuppressive therapy have been recently published, albeit after many patients in this subpopulation have already been vaccinated.

Conclusion

This case series brings attention to the limited humoral response to vaccines in patients treated with rituximab, highlights existing guidelines and their limitations, and raises future considerations about the potential benefits to testing vaccine responsiveness.

KEYWORDS:

• Vaccination
• vaccine
• COVID-19
• rituximab
• rituxan
• antibody response
• B cells

Disclosure of financial/other conflicts of interest

The authors have no relevant conflicts of interest to disclose. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Consent for publication

The patients provided consent for this case report. All identifying details have been omitted.

Authors’ contributions

TS, EAB, MGC wrote and reviewed the manuscript.

Additional information

Funding

No funding has been received for the production of this manuscript.