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Rituximab-induced interstitial lung disease: five case reports.

Naqibullah M, Shaker SB, Bach KS, Bendstrup E - Eur Clin Respir J (2015)

Bottom Line: Recently, RTX has also been suggested for the treatment of certain connective tissue disease-related interstitial lung diseases (ILD) and hypersensitivity pneumonitis.Rare but serious pulmonary adverse reactions are reported.To raise awareness about this serious side effect of RTX treatment, as the indication for its use increases with time, we report five cases of probable RTX-ILD and discuss the current literature on this potentially lethal association.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, Gentofte University Hospital, Copenhagen, Denmark.

ABSTRACT
Rituximab (RTX), a mouse/human chimeric anti-CD20 IgG1 monoclonal antibody has been effectively used as a single agent or in combination with chemotherapy regimen to treat lymphoma since 1997. In addition, it has been used to treat idiopathic thrombocytopenic purpura, systemic lupus erythematous, rheumatoid arthritis, and autoimmune hemolytic anemia. Recently, RTX has also been suggested for the treatment of certain connective tissue disease-related interstitial lung diseases (ILD) and hypersensitivity pneumonitis. Rare but serious pulmonary adverse reactions are reported. To raise awareness about this serious side effect of RTX treatment, as the indication for its use increases with time, we report five cases of probable RTX-ILD and discuss the current literature on this potentially lethal association.

No MeSH data available.


Related in: MedlinePlus

HRCT of the lungs showing diffuse ground glass opacity and fine reticulation with sparing of the immediate subpleural lung tissue on axial and sagittal planes.
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Figure 0001: HRCT of the lungs showing diffuse ground glass opacity and fine reticulation with sparing of the immediate subpleural lung tissue on axial and sagittal planes.

Mentions: A 68-year-old man with diffuse large B-cell lymphoma was referred with respiratory symptoms, 5 months after treatment with three cycles of RTX, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). Prior to initiation of therapy, he had no respiratory symptoms and a normal computed tomography (CT) of the lungs. On referral, the patient complained of exertional dyspnea, cough, and fever. Physical examination revealed tachypnea, normal breath sounds, and normal saturation at rest. Lung function test (LFT) demonstrated a restrictive pattern with a reduced diffusion capacity for carbon monoxide (DLco 45%). Chest high-resolution (HR) CT demonstrated lung fields with diffuse ground glass opacities (GGO) and fine sub-pleural reticulation with sparing of the immediate sub-pleural lung, a pattern compatible with non-specific interstitial pneumonitis (NSIP) (Fig. 1). The diagnosis of RTX-ILD was made on clinical and radiological basis in multidisciplinary conference with no further need for invasive investigation. RTX therapy was immediately discontinued and the patient's condition stabilized without the need for steroid therapy. On follow-up, the patient's respiratory symptoms were completely recovered. His chest CT and DLco were normalized.


Rituximab-induced interstitial lung disease: five case reports.

Naqibullah M, Shaker SB, Bach KS, Bendstrup E - Eur Clin Respir J (2015)

HRCT of the lungs showing diffuse ground glass opacity and fine reticulation with sparing of the immediate subpleural lung tissue on axial and sagittal planes.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4629765&req=5

Figure 0001: HRCT of the lungs showing diffuse ground glass opacity and fine reticulation with sparing of the immediate subpleural lung tissue on axial and sagittal planes.
Mentions: A 68-year-old man with diffuse large B-cell lymphoma was referred with respiratory symptoms, 5 months after treatment with three cycles of RTX, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). Prior to initiation of therapy, he had no respiratory symptoms and a normal computed tomography (CT) of the lungs. On referral, the patient complained of exertional dyspnea, cough, and fever. Physical examination revealed tachypnea, normal breath sounds, and normal saturation at rest. Lung function test (LFT) demonstrated a restrictive pattern with a reduced diffusion capacity for carbon monoxide (DLco 45%). Chest high-resolution (HR) CT demonstrated lung fields with diffuse ground glass opacities (GGO) and fine sub-pleural reticulation with sparing of the immediate sub-pleural lung, a pattern compatible with non-specific interstitial pneumonitis (NSIP) (Fig. 1). The diagnosis of RTX-ILD was made on clinical and radiological basis in multidisciplinary conference with no further need for invasive investigation. RTX therapy was immediately discontinued and the patient's condition stabilized without the need for steroid therapy. On follow-up, the patient's respiratory symptoms were completely recovered. His chest CT and DLco were normalized.

Bottom Line: Recently, RTX has also been suggested for the treatment of certain connective tissue disease-related interstitial lung diseases (ILD) and hypersensitivity pneumonitis.Rare but serious pulmonary adverse reactions are reported.To raise awareness about this serious side effect of RTX treatment, as the indication for its use increases with time, we report five cases of probable RTX-ILD and discuss the current literature on this potentially lethal association.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, Gentofte University Hospital, Copenhagen, Denmark.

ABSTRACT
Rituximab (RTX), a mouse/human chimeric anti-CD20 IgG1 monoclonal antibody has been effectively used as a single agent or in combination with chemotherapy regimen to treat lymphoma since 1997. In addition, it has been used to treat idiopathic thrombocytopenic purpura, systemic lupus erythematous, rheumatoid arthritis, and autoimmune hemolytic anemia. Recently, RTX has also been suggested for the treatment of certain connective tissue disease-related interstitial lung diseases (ILD) and hypersensitivity pneumonitis. Rare but serious pulmonary adverse reactions are reported. To raise awareness about this serious side effect of RTX treatment, as the indication for its use increases with time, we report five cases of probable RTX-ILD and discuss the current literature on this potentially lethal association.

No MeSH data available.


Related in: MedlinePlus