{
  "abstract": "Background COVID-19 may persist or relapse in patients on B-cell depleting biologic therapies.Objective To examine the rate and outcome of persistent-relapsing COVID-19 (prCOVID-19) in patients with autoimmune rheumatic diseases (AIRD) treated with rituximab (RTX).Methods Single-centre, retrospective cohort study of patients diagnosed with prCOVID-19 (June 2021 to January 2025). prCOVID-19 was defined as persistence of symptoms and lung imaging findings for >30 days, along with persistently positive or PCR-based conversion in upper or lower respiratory tract samples.Results 26 out of 225 (11.6%) AIRD patients, previously diagnosed with COVID-19 during RTX treatment period, developed 27 prCOVID-19 events (females: 20 (76.9%), median age: 61 years, median disease duration: 5.5 years, ≥3 COVID-19 vaccine doses: 20 (76.9%)). No prCOVID-19 infection in a control sample of 661 patients treated with other biologic/targeted synthetic/conventional synthetic disease-modifying antirheumatic drugs was documented. Median cumulative RTX dose was 12 g, while in 17 (68%) prCOVID-19 events, IgG levels were below 700 mg/L. Median duration of prCOVID-19 infection was 65 (IQR 74) days and median duration of hospitalisation 10.5 (IQR 14) days. 11 patients (42.3%) had ≥2 hospitalisations, 3 patients needed mechanical ventilation and 4 deaths were recorded. 59 of 113 (52.2%) nasopharyngeal PCR samples (NPS) and 12/17 (70.6%) bronchoalveolar lavage (BAL) PCR samples were positive during prCOVID-19. Bronchoscopy established the diagnosis of prCOVID-19 in 33% of events.Conclusion AIRD patients treated with RTX are at risk for prCOVID-19. In such patients, the diagnostic accuracy of NPS PCR is suboptimal, necessitating PCR testing in BAL when prCOVID-19 is highly suspected.",
  "authors": [
    {
      "affiliations": [
        "Rheumatology-Clinical Immunology Unit, 4th Department of Internal Medicine, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece"
      ],
      "name": "Katerina Chavatza"
    },
    {
      "affiliations": [
        "4th Department of Internal Medicine, Attikon University General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece"
      ],
      "name": "Elisavet Mastrostamati"
    },
    {
      "affiliations": [
        "4th Department of Internal Medicine, Attikon University General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece"
      ],
      "name": "Charalampos Charalampidis"
    },
    {
      "affiliations": [
        "2nd Department of Pulmonary Medicine, Attikon University General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece"
      ],
      "name": "Elvira-Markela Antonogiannaki"
    },
    {
      "affiliations": [
        "4th Department of Internal Medicine, Attikon University General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece"
      ],
      "name": "Ioannis Grigoropoulos"
    },
    {
      "affiliations": [
        "4th Department of Internal Medicine, Attikon University General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece"
      ],
      "name": "Emmanouil Karofylakis"
    },
    {
      "affiliations": [
        "4th Department of Internal Medicine, Attikon University General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece"
      ],
      "name": "Foteini Gkolemi"
    },
    {
      "affiliations": [
        "4th Department of Internal Medicine, Attikon University General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece"
      ],
      "name": "Georgios Koromvokis"
    },
    {
      "affiliations": [
        "4th Department of Internal Medicine, Attikon University General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece"
      ],
      "name": "Electra Kalara"
    },
    {
      "affiliations": [
        "Rheumatology-Clinical Immunology Unit, 4th Department of Internal Medicine, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece"
      ],
      "name": "Eleni Sambatakaki"
    },
    {
      "affiliations": [
        "Rheumatology-Clinical Immunology Unit, 4th Department of Internal Medicine, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece"
      ],
      "name": "Antonis Fanouriakis"
    },
    {
      "affiliations": [
        "4th Department of Internal Medicine, Attikon University General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece"
      ],
      "name": "Konstantinos Thomas"
    }
  ],
  "title": "Persistent-relapsing SARS-CoV-2 infection following rituximab treatment for autoimmune rheumatic diseases: diagnosis and outcomes",
  "uid": "1cc5f96e-f21d-5ee8-8144-87a55180cca8"
}