Abstract
BackgroundConsequences of long-term B cell depletion with rituximab are not well understood. We describe inflammatory vaginitis as a potential side effect of long-term rituximab treatment, distinct from previously described vulvovaginal pyoderma gangrenosum.MethodsWe performed a retrospective analysis of women treated with rituximab for more than 1 year to determine the prevalence and clinical characteristics of vaginitis cases. We conducted a case–control analysis with up to 3 controls for each vaginitis case.ResultsWe identified sixteen inflammatory vaginitis cases. Women with vaginitis were age 23–68 (median 42), primarily being treated for ANCA-associated vasculitis (11/16; 69%). Most reported copious vaginal discharge (100%) and pain with sex (75%). All women with return of circulating B-cells to > 10 cells/mL had complete (5/9) or significant (4/9) improvement in symptoms. In case–control analysis there was no significant difference in length of B-cell depletion, immune parameters, creatinine levels, and history of neutropenia.ConclusionInflammatory vaginitis is a potential side effect of prolonged continuous B cell depletion with rituximab. More studies are needed to characterize the incidence and etiology of vaginitis among women on long term rituximab therapy and establish a causal relationship.
Highlights
Consequences of long-term B cell depletion with rituximab are not well understood
Cases were identified from a database of patients treated with rituximab for autoimmune disease between November 8, 2002 and April 29, 2020 at the Vasculitis and Glomerulonephritis Center (VGC) of Massachusetts General Hospital, a tertiary-care referral and treatment center
We identified 454 women treated with rituximab for autoimmune disease, of whom 279 (61%) had ANCAassociated vasculitis, 32 (7%) had membranous nephropathy, 21 (4.6%) had minimal change disease or idiopathic focal segmental glomerulosclerosis, 18 (4%) had lupus nephritis, and 104 (23%) had another diagnosis or multiple diagnoses
Summary
We describe inflammatory vaginitis as a potential side effect of long-term rituximab treatment, distinct from previously described vulvovaginal pyoderma gangrenosum. The main clinical entity described to date has been vulvovaginal pyoderma gangrenosum [5,6,7,8]. It presents with painful vulvar and/or perianal ulcerations with vaginal discharge and irritation. Patients are treated with intravenous immune globulin (IVIG), glucocorticoids, and/or discontinuation of rituximab. These descriptions are limited to a few case reports, and remain poorly understood
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