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Intern Med . A Case of Recurrent COVID-19 Pneumonia Following Rituximab Therapy: Treatment Informed by a Serial Transbronchial Lung Cryobiopsy, BALF S

tetano

Editor, Senior Moderator
Intern Med

. 2026 Oct 29.
doi: 10.2169/internalmedicine.7725-26. Online ahead of print.

A Case of Recurrent COVID-19 Pneumonia Following Rituximab Therapy: Treatment Informed by a Serial Transbronchial Lung Cryobiopsy, BALF SARS-CoV-2 PCR, and the Clinical Course​


Jun Hayashi 1 , Tatsuya Nagai 1 , Kurumi Seki 2 , Masanori Toho 3 , Yuki Sato 1 , Hiroki Kawakami 1 , Soichiro Yamaji 1 , Hikaru Ito 1 , Ayumu Otsuki 1 , Hiroyuki Ito 1 , Ryosuke Osawa 4 , Junya Fukuoka 2 , Kosei Matsue 3 , Kei Nakashima 1

Affiliations Expand


Abstract​


Coronavirus disease 2019 (COVID-19) presents with diagnostic and therapeutic challenges in immunocompromised patients, particularly those receiving anti-CD20 antibody therapy. This report describes a patient with recurrent pneumonia following COVID-19 after receiving anti-CD20 antibody therapy. Two transbronchial lung cryobiopsies documented active lung injury in two clinically distinct episodes. Based on an integrated assessment of the histopathological findings, bronchoalveolar lavage fluid SARS-CoV-2 PCR results, and the clinical course, antiviral and corticosteroid therapies were administered, followed by an improvement in the clinical course. This case suggests that cryobiopsy-based histopathology, integrated with the virological findings and clinical course, may provide complementary information for treatment selection in this patient population.

Keywords: COVID-19; acute lung injury; persistent infection; rituximab; transbronchial lung cryobiopsy.
 
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