Clinical analysis of rituximab-induced interstitial lung disease

Abstract

Objective: To investigate the clinical characteristics, diagnosis-treatment points and prognosis of rituximab-induced interstitial lung disease (R-ILD), and to improve the recognition of this disease. Methods: The clinical data on 4 cases of R-ILD were analyzed retrospectively, and the related literatures were reviewed. The literature review was carried out respectively in Wanfang Data, CNKI and PubMed by October 2016 with"rituximab"and"interstitial lung disease"or"interstitial pneumonitis"as the search terms. Results: The all 4 patients received chemotherapy including rituximab, had respiratory symptoms after 2 to 5 cycles chemotherapy respectively. The chest computerized tomography findings of all 4 cases showed diffuse ground glass opacities. In all of the patients, the diagnosis of R-ILD was made and glucocorticoids therapy was initiated. After treatment, the clinical symptoms improved promptly and follow-up chest computerized tomography showed pulmonary lesions significantly resolved. Literature review found 48 articles (2 reviews, 6 original articles, 39 case reports and 1 other article) . 50 cases of R-ILD were collected and the chief complaint were dyspnea, cough and fever. The ground-glass pattern on the CT scan of the chest was the important feature of this disease. Therapy included glucocorticoids, discontinuation of rituximab, and any other clinically necessary measures. Conclusions: Rituximab can cause interstitial lung disease. The diagnosis relies on clinical manifestation and radiological findings. The good prognosis depends on prompt discontinuation of rituximab and treatment with glucocorticoids.