• Nicholas L DePace, Stephen Soloway, David Roshal, Alyxandra Morgan Soloway, and Joe Colombo.
• aPennsylvania Hospital of the University of Pennsylvania Health System, Philadelphia, PA bStephen Soloway, Rheumatology, Vineland, NJ, USA cJefferson Health, New Jersey Division, Rowan University School of Osteopathic Medicine, Stratford, NJ dFranklin Cardiovascular Associates, PA, Sewell, NJ.
• Medicine (Baltimore). 2020 Jul 24; 99 (30): e21377.

RationaleIt is recommended that patients with Rheumatic diseases that are at high risk of developing active infections be screened for Tuberculosis, Hepatitis B, and Hepatitis C before receiving second-line immunosuppressive therapies. With the emergence 2019 novel coronavirus (SARS-CoV-2), expanded guidelines have not been proposed for screening in these patients before starting advanced therapy.Patient ConcernsWe present an unique circumstance whereas a patient with a 5 year history of inflammatory muscle disease, diagnosed by clinical history and muscle biopsy with elevated creatine kinase levels, suffered a hypoxemic cardiopulmonary arrest due to asymptomatic SARS-CoV-2 after receiving advanced immunosuppressive therapy.DiagnosesThe patient presented with an acute exacerbation of inflammatory muscle disease with dysphagia, muscle weakness, and elevated creatine kinase.InterventionsAfter no improvement with intravenous immunoglobulin the patient received mycophenolate and plasma exchange therapy.OutcomesSubsequently the patient suffered a fatal hypoxemic cardiopulmonary arrest. Polymerase chain reaction test was positive for SARS-CoV-2 RNA.LessonsWe conclude that rheumatic patients, asymptomatic for SARS-CoV-2 infection, be screened and tested before initiating second-line immunosuppressive treatment.

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