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Review
. 2023 Feb;12(1):27-31.
doi: 10.1007/s13730-022-00711-4. Epub 2022 Jun 22.

Use of rituximab in SARS-CoV-2-positive renal transplant recipient with EBV reactivation and probable haemophagocytic lymphohistiocytosis

Derek Chan  1   2 , Sabina Karimi  1 , George Follows  2 , Nicholas Torpey  1 , Ondrej Suchanek  3
Affiliations
Review

Use of rituximab in SARS-CoV-2-positive renal transplant recipient with EBV reactivation and probable haemophagocytic lymphohistiocytosis

Derek Chan et al. CEN Case Rep. 2023 Feb.

Abstract

We present a case of a rapid clinical recovery in a critically ill kidney transplant recipient with SARS-CoV-2 positivity, Epstein-Barr virus (EBV) reactivation and probable secondary hemophagocytic lymphohistiocytosis (HLH) treated with etoposide-free regimen, based on dexamethasone and a single dose of rituximab. Although rituximab is often a part of EBV-HLH treatment strategy, its use in simultaneous Coronavirus 2019 disease (COVID-19) and solid-organ transplantation has not been reported yet. We review the current evidence for the potential of SARS-CoV-2 to trigger EBV reactivation, leading to a severe clinical illness. Finally, we compare the clinical features of hyper-inflammatory response typical for severe COVID-19 and classical secondary HLH and discuss the benefits of therapeutic B-cell depletion in both conditions.

Keywords: B cell; COVID-19; EBV reactivation; Haemophagocytic lymphohistiocytosis; Renal transplant; Rituximab.

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Conflict of interest statement

The authors have declared that no conflict of interest exists.

Figures

Fig. 1
Fig. 1
Axial CT images of the abdomen pre- (A) and 18 days post-treatment (B). Splenomegaly, with mediastinal, porta hepatis and para-aortic lymph node enlargement is demonstrated in A and its significant reduction in B. Splenic transverse diameter (yellow line) and corresponding measurement shown
Fig. 2
Fig. 2
Dynamics of key laboratory markers in response to treatment. Patient’s daily serum creatinine (red line), alanine transaminase (blue line) and CRP (black line) measurements during his hospital admission are shown. Periods of renal replacement (red shading), dexamethasone (grey shading) and rituximab therapy (RTX; black arrow) with antimicrobial coverage (green shading) are indicated
See this image and copyright information in PMC

References

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