Abstract
To the Editor: Rituximab (RTX) is an anti-CD20 antibody used in patients with rheumatoid arthritis (RA) after failure of anti-tumor necrosis factor (anti-TNF) therapy. Side effects are mainly infectious, probably related to B cell lymphopenia. However, opportunistic infections are not frequent with use of RTX. We describe a case of cytomegalovirus (CMV) colitis in a patient with RA with hypo-IgG after 2 cycles of RTX. A 66-year-old woman was followed for 18 years for RA with positive anticitrullinated protein antibodies and structural erosions. She was successively treated with methotrexate (MTX) alone for 17 years and then in combination with anti-TNF-α for 9 months (adalimumab, then etanercept), without success. She improved after a first course of RTX (1 gram twice) in 2007 associated with low-dose corticosteroid therapy (prednisone 10 mg daily) and MTX 10 mg. In July 2008, the serum IgG level was found to be low: 5.25 g/l; IgG level was not monitored … Address correspondence to Prof. Mariette; E-mail: xavier.mariette{at}bct.aphp.fr
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