{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T20:32:08Z","timestamp":1787776328299,"version":"build-2784847793"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:p>Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system, characterized by the destruction of the myelin sheath of nerves. MS patients treated with rituximab, an immunosuppressive drug, experience reduced immunoglobulin levels, which increases their risk of various infections, including coronavirus disease 2019 (COVID-19). During the COVID-19 pandemic, many of these patients developed long-term symptoms following infection. These chronic symptoms have led to significant complications and, in some cases, increased mortality. In this case series study, we investigated long COVID-19 symptoms in MS patients treated with rituximab and the effects of intravenous immunoglobulin (IVIG) therapy in alleviating chronic symptoms. The results demonstrated that the patients\u2019 long-term symptoms responded to IVIG treatment, with significant improvements in respiratory symptoms, fever, immune parameters, and a reduction in C-reactive protein levels. This study highlights the importance of targeted management of long COVID-19 in immunocompromised populations and suggests that COVID-19 patients with immune deficiencies require specific therapeutic approaches.<\/jats:p>","DOI":"10.4103\/jrms.jrms_150_25","type":"journal-article","created":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T03:00:10Z","timestamp":1748228410000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Investigating outcomes and treatment of long coronavirus disease 2019 in patients with multiple sclerosis treated with rituximab: A case series study"],"prefix":"10.4103","volume":"30","author":[{"given":"Kiana","family":"Shirani","sequence":"first","affiliation":[{"name":"Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farzin","family":"Khorvash","sequence":"additional","affiliation":[{"name":"Immunodeficiency Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alireza","family":"Karamshahi","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asieh","family":"Maghamimehr","sequence":"additional","affiliation":[{"name":"Department of Statistics, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,5]]},"reference":[{"key":"R2-20250526","first-page":"352","article-title":"Immune responses to SARS-CoV-2 vaccination in MS patients on anti-CD20 therapy","volume":"91","author":"Apostolidis","year":"2022","journal-title":"Ann Neurol"},{"key":"R3-20250526","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1056\/NEJMra1401483","article-title":"Multiple sclerosis","volume":"378","author":"Reich","year":"2018","journal-title":"N Engl J Med"},{"key":"R4-20250526","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1056\/NEJMoa0706383","article-title":"B-cell depletion with rituximab in relapsing-remitting multiple sclerosis","volume":"358","author":"Hauser","year":"2008","journal-title":"N Engl J Med"},{"key":"R5-20250526","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.ebiom.2017.01.042","article-title":"Memory B cells are major targets for effective immunotherapy in relapsing multiple sclerosis","volume":"16","author":"Baker","year":"2017","journal-title":"EBioMedicine"},{"key":"R6-20250526","first-page":"2891","article-title":"Long COVID in patients with multiple sclerosis: A case series","volume":"28","author":"Riva","year":"2021","journal-title":"Eur J Neurol"},{"key":"R7-20250526","first-page":"e144","article-title":"Prolonged SARS-CoV-2 infection following rituximab therapy","volume":"75","author":"Thornton","year":"2022","journal-title":"Clin Infect Dis"},{"key":"R8-20250526","article-title":"Clinical guidelines for multiple sclerosis management during COVID-19","year":"2021"},{"key":"R9-20250526","first-page":"2345","article-title":"Impact of rituximab on COVID-19 outcomes in MS patients","volume":"269","author":"Johnson","year":"2022","journal-title":"J Neurol"},{"key":"R10-20250526","first-page":"245","article-title":"Drayson MT. 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