Second COVID-19 infection in a patient with granulomatosis with polyangiitis on rituximab

INTRODUCTION Observational data suggest there may be an association between rituximab and severe COVID-19 outcomes. AntiCD20 therapies impair humoral response, theoretically increasing the risk of prolonged SARSCoV-2 infection and shedding, as well as subsequent reinfection. Here, we report a patient with granulomatosis with polyangiitis (GPA) being treated with rituximab who appears to have developed recurrent SARSCoV-2 infections in the setting of highrisk employment and on recovery ultimately had no detectable SARSCoV-2 IgG antibodies. This case highlights a potential risk of rituximab in patients with rheumatic disease, which will become especially relevant as rituximab may impair the immunogenicity of SARSCoV-2 vaccines.