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Background: Organizing pneumonia (OP), an interstitial lung disease, has been observed in patients with inflammatory demyelinating diseases (IDDs) treated with anti-CD20, particularly after COVID-19, but data are limited., Aim: To provide a detailed characterization of COVID-19-associated OP in IDD patients treated with anti-CD20., Methods: Bi-centric retrospective cohort study including patients with multiple sclerosis (MS), aquaporin-4-positive neuromyelitis optica spectrum disorder (AQP4 + NMOSD), and myelin oligodendrocyte glycoprotein antibody disease (MOGAD) who received anti-CD20 and were diagnosed with COVID-19-associated OP between March 2020 and October 2023., Results: Nineteen patients were included (mean age 46.8 years; 52.6% female; 63% rituximab, 37% ocrelizumab). Sixteen had MS, two MOGAD, and one AQP4 + NMOSD. Intermittent fever was the predominant symptom. Hospitalization occurred in all but one patient, without fatalities. Chest CT consistently showed OP patterns. Thirteen patients had positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR in bronchoalveolar lavage. Treatments included corticosteroids, antivirals, monoclonal antibodies, and convalescent plasma. Fourteen patients postponed infusions; nine resumed post-recovery (median 11.9 months), two switched due to hypogammaglobulinemia, and three stopped. After a mean follow-up of 1.5 years, lung abnormalities and clinical manifestations resolved in 18 patients; however, 13 experienced long-COVID., Conclusions: In anti-CD20-treated patients with recurrent fever and distinctive CT features, COVID-19-associated OP should be considered., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: R Carvajal is currently being funded by a Research grand from the European Charcot Foundation. In 2023, he received a grant by “Vall d′Hebron Institut de Recerca.” In 2021, he received an ECTRIMS Fellowship training performed during 2021–2022. He has also received speaking honoraria from Roche, Novartis, Biogen, Merck, and Sanofi.B Rodríguez-Acevedo has received speaking honoraria from Merck and honoraria for consulting services from Novartis.L García-Vasco has received honoraria as a speaker from Merck and Novartis; and received support for attending meetings and congresses from BMS, Horizon, Janssen, Novartis and Sanofi.A Zabalza has a predoctoral grant Rio Hortega, from the Instituto de Salud CarlosIII, Spain (CM22/00237), received travel expenses for scientific meetings from Biogen-Idec, Merck Serono and Novartis; speaking honoraria from Eisai; and a study grant from Novartis.H Ariño has received grant from Instituto de Salud Carlos III, Spain; JR22/00072.L Bollo is supported by a 1-year stipend endowed by the NMSS/AAN John Dystel Prize for Multiple Sclerosis Research awarded to Prof. Xavier Montalban in 2022.N Cabello-Clotet has received support for attending meetings and congresses and honoraria as a speaker from Gilead, GSK Janssen, and MSD.A Cobo-Calvo has received grant from Instituto de Salud Carlos III, Spain; JR19/00007.M Comabella has received compensation for consulting services and speaking honoraria from Bayer Schering Pharma, Merck Serono, Biogen-Idec, Teva Pharmaceuticals, Sanofi-Aventis, Genzyme, and Novartis.A García-Sarreón is currently an ECTRIMS clinical fellowship awardee for 2023–2024 and receives support from ECTRIMS.S Otero-Romero has received speaking and consulting honoraria from Genzyme, Biogen-Idec, Novartis, Roche, Excemed and MSD; as well as research support from Novartis.A Pappolla has received funding travel from Roche and speaking honoraria from Novartis. He performed an ECTRIMS Clinical Training Fellowship program during 2021, and is currently performing an MSIF-ARSEP Fellowship program.J Rio has received speaking honoraria and personal compensation for participating on Advisory Boards from Biogen-Idec, Genzyme, Janssen, Merck- Serono, Novartis, Teva, Roche, and Sanofi-Aventis.P Tagliani has received support during one year as an ECTRIMS clinical fellowship awardee in 2019–2020.C Tur is currently being funded by a Miguel Servet contract, awarded by the Instituto de Salud Carlos III (ISCIII), Ministerio de Ciencia e Innovación de España (CP23/00117). She has also received a 2020 Junior Leader La Caixa Fellowship (fellowship code: LCF/BQ/PI20/11760008), awarded by “la Caixa” Foundation (ID 100010434), a 2021 Merck’s Award for the Investigation in MS awarded by Fundación Merck Salud (Spain), a 2021 Research Grant (PI21/01860) awarded by the ISCIII, Ministerio de Ciencia e Innovación de España, and a FORTALECE research grant (FORT23/00034) also by the ISCIII, Ministerio de Ciencia e Innovación de España. In 2015, she received an ECTRIMS Post-doctoral Research Fellowship and has received funding from the UK MS Society. She is a member of the Editorial Board of Neurology Journal and Multiple Sclerosis Journal. She has also received honoraria from Roche, Novartis, Merck, Immunic Therapeutics, and Bristol Myers Squibb. She is a steering committee member of the O’HAND trial and of the Consensus group on Follow-on DMTs.A Vidal-Jordana has received support has received support for contracts Juan Rodes (JR16/00024) and from Fondo de Investigación en Salud (PI17/02162 and PI22/01589) from Instituto de Salud Carlos III, Spain, and has engaged in consulting and/or participated as speaker in events organized by Roche, Novartis, and Merck.A Vilaseca has received a Rio Hortega grant (CM22/00247) by Institute of Health Carlos III (ISCIII).A Villar has engaged in consulting and/or participated as a speaker in events organized by Boehringer Ingelheim, Roche, Janssen, and Glaxo, with travel expenses covered by Boehringer Ingelheim, Roche, Glaxo, Chiesi, and Novartis for participation in scientific meetings. In addition, research support has been received from Janssen and GlaxoSmithKline.J Sastre-Garriga serves as co-Editor for Europe on the editorial board of Multiple Sclerosis Journal and as Editor-in-Chief in Revista de Neurología, receives research support from Fondo de Investigaciones Sanitarias (19/950) and has served as a consultant/speaker for Biogen, Celgene/Bristol Meyers Squibb, Sanofi, Novartis and Merck.C Oreja-Guevara has received honoraria for speaking and serving on advisory boards from Biogen Idec., F. Hoffmann-La Roche Ltd, Sanofi-Genzyme, Merck, Janssen, BMS, Novartis and Teva.M Tintoré has received compensation for consulting services, speaking honoraria and research support from Almirall, Bayer Schering Pharma, Biogen-Idec, Genzyme, Immunic Therapeutics, Janssen, Merck-Serono, Novartis, Roche, Sanofi-Aventis, Viela Bioand Teva Pharmaceuticals. Data Safety Monitoring Board for Parexel and UCB Biopharma, Relapse Adjudication Committee for IMCYSE SA.X Montalban has received speaking honoraria and travel expenses for participation in scientific meetings, has been a steering committee member of clinical trials or participated in advisory boards of clinical trials in the past years with Abbvie, Actelion, Alexion, Biogen, Bristol-Myers Squibb/Celgene, EMD Serono, Genzyme, Hoffmann-La Roche, Immunic, Janssen Pharmaceuticals, Medday, Merck, Mylan, Nervgen, Novartis, Sandoz, Sanofi-Genzyme, Teva Pharmaceutical, TG Therapeutics, Excemed, MSIF and NMSS.G Arrambide has received speaking honoraria and consulting services or participation in advisory boards from Sanofi, Roche and Horizon Therapeutics/Amgen; and travel expenses for scientific meetings from Novartis, Roche, ECTRIMS and EAN.J Castillo, A Falcó-Roget, I Galan, I Gómez-Estévez, G Granados, G Mato-Chain, D La Puma, L Midaglia, A Nieto-García, M Rodríguez, and I Sansano report no disclosures.