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Rituximab-induced interstitial lung disease in a patient with follicular lymphoma: A rare case report.

Aagre S, Patel A, Kendre P, Anand A - Lung India (2015 Nov-Dec)

Bottom Line: Diagnostic high-resolution computed tomography (HRCT) of the lungs revealed bilateral patchy ground glass opacities suggestive of interstitial lung disease (ILD).It was managed successfully with supplemental oxygen and corticosteroids with discontinuation of the Rituximab.Extensive review of the literature did not reveal ample of material on rituximab-induced ILD (RTX-ILD).

View Article: PubMed Central - PubMed

Affiliation: Department of Medical and Pediatric Oncology, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India.

ABSTRACT
Rituximab is a chimeric monoclonal antibody that targets CD-20 antigen expressed in more than 90% of all B cell non-Hodgkin's lymphoma (NHL). We report a case of 33-year-old female without any comorbidities, newly diagnosed with stage IIIB follicular lymphoma treated with rituximab-based chemotherapy. Patient developed exertional dyspnea and dry cough after the fourth cycle of rituximab-based chemotherapy. Diagnostic high-resolution computed tomography (HRCT) of the lungs revealed bilateral patchy ground glass opacities suggestive of interstitial lung disease (ILD). It was managed successfully with supplemental oxygen and corticosteroids with discontinuation of the Rituximab. Extensive review of the literature did not reveal ample of material on rituximab-induced ILD (RTX-ILD).

No MeSH data available.


Related in: MedlinePlus

High-resolution computed tomography (HRCT) scan of the lung: On axial lung window images, there are patchy ground glass opacities noted in bilateral lung fields, more in upper lobes
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Figure 2: High-resolution computed tomography (HRCT) scan of the lung: On axial lung window images, there are patchy ground glass opacities noted in bilateral lung fields, more in upper lobes

Mentions: A 33-year-old non-smoker female patient presented with generalized lymphadenopathy involving neck, axilla, abdomen and inguinal region. She had a history suggestive of B symptoms but there was no prior history of diabetes mellitus, dyslipidemia or occupational exposure to any kind of dusts. Her height, weight, and body surface area (BSA) were 170 cm, 67 kg, and 1.78, respectively. Routine blood tests including complete blood count, renal and liver function tests were within normal limits. Excisional lymph node biopsy showed infiltration by small, medium-sized lymphoid cells which appear to be forming follicles. Immunohistochemistry markers were positive for CD-10, CD-20, Bcl-2, Bcl-6 and Ki-67 proliferation index was 22%. Bone marrow was uninvolved. These findings were consistent with the diagnosis of stage IIIB FL. She was treated with R-CHOP 21 regimen consisting of three weekly rituximab (375 mg/m2 of BSA), cyclophosphamide (750 mg/m2 of BSA), doxorubicin (50 mg/m2 of BSA), vincristine (1.4 mg/m2 of BSA), and prednisolone (100 mg daily). After the fourth R-CHOP chemotherapy, she was admitted with the chief complaints of exertional dyspnea and dry cough. There was no history of fever. Physical examination showed tachypnea and bilateral basal crackles. Arterial blood gas analysis revealed hypoxemia. Her routine blood counts, liver function test, renal function test, urine routine/microscopy and D-dimer were normal. The ECG showed sinus tachycardia. A chest X-ray showed bilateral reticulo-nodular infiltrates [Figure 1] and HRCT scan of the lung revealed bilateral patchy ground-glass opacities, suggestive of interstitial lung disease (ILD) [Figure 2]. The pulmonary function testing (PFT) showed a restrictive pattern [Table 1]. As it is quite difficult to rule out other causes of ILD in cancer patients, various microbiological tests were carried out to rule out respiratory tract infections. Sputum examination for Gram stain, Zn stain for acid-fast bacilli as well as for fungi and Pneumocystis carinii did not reveal any abnormality. Routine bacterial, mycobacterial and fungal cultures were sterile. Antinuclear antibody (ANA) and antineutrophil cytoplasmic antibody (ANCA) were negative. BAL fluid cytology was negative for malignant cells. Pulmonary eosinophilia was excluded based on symptomatology and laboratory diagnosis. Patient did not have symptoms like persistent or recurrent cough aggravated at night, weight loss, low grade fever; she was a resident of non-endemic area for filariasis, there was no peripheral eosinophilia, and peripheral blood did not show any presence of abnormal organism. Hence we did not consider lung biopsy for the same.


Rituximab-induced interstitial lung disease in a patient with follicular lymphoma: A rare case report.

Aagre S, Patel A, Kendre P, Anand A - Lung India (2015 Nov-Dec)

High-resolution computed tomography (HRCT) scan of the lung: On axial lung window images, there are patchy ground glass opacities noted in bilateral lung fields, more in upper lobes
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663870&req=5

Figure 2: High-resolution computed tomography (HRCT) scan of the lung: On axial lung window images, there are patchy ground glass opacities noted in bilateral lung fields, more in upper lobes
Mentions: A 33-year-old non-smoker female patient presented with generalized lymphadenopathy involving neck, axilla, abdomen and inguinal region. She had a history suggestive of B symptoms but there was no prior history of diabetes mellitus, dyslipidemia or occupational exposure to any kind of dusts. Her height, weight, and body surface area (BSA) were 170 cm, 67 kg, and 1.78, respectively. Routine blood tests including complete blood count, renal and liver function tests were within normal limits. Excisional lymph node biopsy showed infiltration by small, medium-sized lymphoid cells which appear to be forming follicles. Immunohistochemistry markers were positive for CD-10, CD-20, Bcl-2, Bcl-6 and Ki-67 proliferation index was 22%. Bone marrow was uninvolved. These findings were consistent with the diagnosis of stage IIIB FL. She was treated with R-CHOP 21 regimen consisting of three weekly rituximab (375 mg/m2 of BSA), cyclophosphamide (750 mg/m2 of BSA), doxorubicin (50 mg/m2 of BSA), vincristine (1.4 mg/m2 of BSA), and prednisolone (100 mg daily). After the fourth R-CHOP chemotherapy, she was admitted with the chief complaints of exertional dyspnea and dry cough. There was no history of fever. Physical examination showed tachypnea and bilateral basal crackles. Arterial blood gas analysis revealed hypoxemia. Her routine blood counts, liver function test, renal function test, urine routine/microscopy and D-dimer were normal. The ECG showed sinus tachycardia. A chest X-ray showed bilateral reticulo-nodular infiltrates [Figure 1] and HRCT scan of the lung revealed bilateral patchy ground-glass opacities, suggestive of interstitial lung disease (ILD) [Figure 2]. The pulmonary function testing (PFT) showed a restrictive pattern [Table 1]. As it is quite difficult to rule out other causes of ILD in cancer patients, various microbiological tests were carried out to rule out respiratory tract infections. Sputum examination for Gram stain, Zn stain for acid-fast bacilli as well as for fungi and Pneumocystis carinii did not reveal any abnormality. Routine bacterial, mycobacterial and fungal cultures were sterile. Antinuclear antibody (ANA) and antineutrophil cytoplasmic antibody (ANCA) were negative. BAL fluid cytology was negative for malignant cells. Pulmonary eosinophilia was excluded based on symptomatology and laboratory diagnosis. Patient did not have symptoms like persistent or recurrent cough aggravated at night, weight loss, low grade fever; she was a resident of non-endemic area for filariasis, there was no peripheral eosinophilia, and peripheral blood did not show any presence of abnormal organism. Hence we did not consider lung biopsy for the same.

Bottom Line: Diagnostic high-resolution computed tomography (HRCT) of the lungs revealed bilateral patchy ground glass opacities suggestive of interstitial lung disease (ILD).It was managed successfully with supplemental oxygen and corticosteroids with discontinuation of the Rituximab.Extensive review of the literature did not reveal ample of material on rituximab-induced ILD (RTX-ILD).

View Article: PubMed Central - PubMed

Affiliation: Department of Medical and Pediatric Oncology, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India.

ABSTRACT
Rituximab is a chimeric monoclonal antibody that targets CD-20 antigen expressed in more than 90% of all B cell non-Hodgkin's lymphoma (NHL). We report a case of 33-year-old female without any comorbidities, newly diagnosed with stage IIIB follicular lymphoma treated with rituximab-based chemotherapy. Patient developed exertional dyspnea and dry cough after the fourth cycle of rituximab-based chemotherapy. Diagnostic high-resolution computed tomography (HRCT) of the lungs revealed bilateral patchy ground glass opacities suggestive of interstitial lung disease (ILD). It was managed successfully with supplemental oxygen and corticosteroids with discontinuation of the Rituximab. Extensive review of the literature did not reveal ample of material on rituximab-induced ILD (RTX-ILD).

No MeSH data available.


Related in: MedlinePlus