Plasma exchange with COVID-19 convalescent plasma in a patient with severe ANCA-associated vasculitis and COVID-19 pneumonia after rituximab therapy

Kochanek, Matthias; Borrega, Jorge Garcia; Beckmann, Laura; Gathof, Birgit S; Di Cristanziano, Veronica; Hagmann, Henning

The combination of COVID-19 pneumonia and pulmonary-renal syndrome due to ANCA‐associated vasculitis (AAV) pose diagnostic uncertainty and a therapeutic dilemma. According to current limited knowledge of COVID-19, the application of commonly used drugs in AAV, cyclophosphamide and rituximab, must be weighed carefully in active COVID-19 infection. We report a case of a 52-year-old male patient with concurrent severe COVID-19 pneumonia and acute relapse of pulmonary-renal syndrome due to AAV after recent rituximab maintenance dose. The patient presented with severe hypoxemia, complete B-cell depletion and SARS-CoV-2 viremia. He was successfully treated with therapeutic plasma exchange employing COVID-19 convalescent plasma.