[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-448000-105":59,"doc-detail-448000-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","persistent-covid-19-pneumonia-in-a-patient-on-rituximab","Persistent COVID-19 Pneumonia in a Patient on Rituximab","","Immunosuppressed patients experience higher morbidity and mortality from SARS-CoV-2 infection due to impaired antibody and cellular immune responses that permit persistent viremia and ongoing virus-driven inflammation. A 52-year-old man receiving rituximab for chronic inflammatory demyelinating polyneuropathy developed pneumonitis after SARS-CoV-2 infection, with recurrent symptoms requiring hospitalization four times within three months. Diagnosis was delayed by multiple negative nasopharyngeal PCR results and limited early response, until bronchoalveolar lavage confirmed active infection. Treated with multimodal therapy including nirmatrelvir/ritonavir, baricitinib, IVIG, and IV methylprednisolone, he achieved prompt and sustained clinical improvement.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/persistent-covid-19-pneumonia-in-a-patient-on-rituximab/448000/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/persistent-covid-19-pneumonia-in-a-patient-on-rituximab/448000.png","ImageObject",300,407,{"name":92,"@type":93},"Emma Wilson","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-02","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why do immunosuppressed patients have worse outcomes with COVID-19?","Question",{"text":112,"@type":113},"They may have reduced protective antibodies and impaired cellular immunity, which prevents clearing the virus and can lead to persistent infection with ongoing inflammation.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What caused the delayed diagnosis in this case?",{"text":117,"@type":113},"Multiple nasopharyngeal SARS-CoV-2 PCR tests were negative and the clinical and radiographic picture initially resembled organizing pneumonia, delaying confirmation of active infection.",{"name":119,"@type":110,"acceptedAnswer":120},"How was the confirmed COVID-19 treated and what was the outcome?",{"text":121,"@type":113},"After confirmation from bronchoalveolar lavage, the patient received multimodal therapy with antiviral and immunomodulatory agents, including nirmatrelvir/ritonavir, baricitinib, IVIG, and IV methylprednisolone, leading to prompt and sustained improvement.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},448000,1790769875,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},3848291630094,"https://eur-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Persistent COVID-19 Pneumonia in a Patient on Rituximab  \nJournal of Investigative Medicine High Impact Case Reports  \nVolume 14: 1–5 © 2026 American Federation for  \nMedical Research DOI: 10. 1177/23247096251411769  \n[journals.sagepub.com/home/hic](journals.sagepub.com/home/hic)  \nKaren Clarke, MD 1, Sathyabama Naidu, MD 1, Claire Wan, PA2,  \nand Samuel Stampfer, MD2  \nAbstract  \nImmunosuppressed patients have increased morbidity and mortality due to SARS-CoV-2 infection. They can have reduced protective antibodies levels or reduced cellular immunity resulting in inability to clear the virus and persistent viremia and virus-induced inflammation. We present the case of a 52-year-old male, immunosuppressed due to use of rituximab for treatment of chronic inflammatory demyelinating polyneuropathy, who developed pneumonitis from SARS-CoV-2 infection. The patient required hospitalization 4 times over a 3-month period due to recurring pneumonitis symptoms, including fever, dyspnea, and a severe cough. The final diagnosis was delayed due to negative SARS-CoV-2 polymerase chain reaction testson 7/8 of nasopharyngeal specimens, as well as failure to clinically improve with administration of remdesivir after the sole positive test. He was thought to have rituximab-induced organizing pneumonia, but his condition gradually worsened with additional immunosuppression directed against that condition. His active SARS-CoV-2 infection was eventually confirmed from a bronchoalveolar lavage specimen on the final hospitalization, and he was then treated with a multimodal regimenthat included an antiviral agent (nirmatrelvir/ritonavir), a Janus Kinase inhibitor (baricitinib), intravenous immunoglobulin, and intravenous methylprednisolone. He had a prompt and sustained clinical response to this multimodal regimen. Persistent COVID-19 should be considered in the differential diagnosis in patients with unexplained organizing pneumonia, and can be treated effectively with multimodal therapy as above.  \nKeywords  \nrituximab, persistent COVID-19, organizing pneumonia, PCR on bronchoalveolar lavage, false negative  \nReceived: September 25, 2025; revised: November 14, 2025; accepted: November 29, 2025  \nIntroduction  \nImmunosuppressed patients have considerably worse clinical outcomes associated with SARS-CoV-2 infection than immunocompetent patients.1 They often do not respond normally to SARS-CoV-2 vaccines, with reduced SARS-CoV-2 cellular (T cell) and humoral (antibody-mediated) immunity compared to immunocompetent individuals.2-4 Some are unable to clear their SARS-CoV-2 infections, allowing replication-competent virus to persist in the lung parenchyma for months, even when asymptomatic.5 This prolonged viral shedding increases the risk of relapse of COVID-19 symptoms in immunosuppressed patients as well as the transmission of SARS-CoV-2 to their contacts. Rituximab, an anti-CD20 chimeric monoclonal antibody, is particularly associated with this through depletion of preplasma B cells, leading to hypogammaglobulinemia. Patients who have received rituximab and then acquire SARS-CoV-2 are  \nunable to produce anti-SARS-CoV-2 antibodies, impeding clearance of the virus.6  \nHere, we present a case of prolonged COVID-19 in a gentleman on rituximab whose ultimate diagnosis was delayed due to multiple negative SARS-CoV-2 nasopharyngeal swabs along with radiographic and clinical features that appeared to be consistent with organizing pneumonia.  \n1 Division of Hospital Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA  \n2Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA  \nCorresponding Author:  \nKaren Clarke, MD, Division of Hospital Medicine, Department of Medicine, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322, USA.  \nEmail: [karen.clarke@emoryhealthcare.org](karen.clarke@emoryhealthcare.org)  \nCreative Commons Non Commercial CC B","cbCaihDTgukQqgfZ","https://ap.wps.com/l/cbCaihDTgukQqgfZ","pdf",518303,"English","# Abstract\n# Keywords\n# Introduction\n# Case Presentation","[{\"question\":\"Why do immunosuppressed patients have worse outcomes with COVID-19?\",\"answer\":\"They may have reduced protective antibodies and impaired cellular immunity, which prevents clearing the virus and can lead to persistent infection with ongoing inflammation.\"},{\"question\":\"What caused the delayed diagnosis in this case?\",\"answer\":\"Multiple nasopharyngeal SARS-CoV-2 PCR tests were negative and the clinical and radiographic picture initially resembled organizing pneumonia, delaying confirmation of active infection.\"},{\"question\":\"How was the confirmed COVID-19 treated and what was the outcome?\",\"answer\":\"After confirmation from bronchoalveolar lavage, the patient received multimodal therapy with antiviral and immunomodulatory agents, including nirmatrelvir/ritonavir, baricitinib, IVIG, and IV methylprednisolone, leading to prompt and sustained improvement.\"}]","Persistent COVID-19 Pneumonia in a Patient on Rituximab | PDF",1790724606,13]