Perianal Crohn Disease after Treatment with Rituximab for Active Granulomatosis with Polyangiitis.

Abstract

To the Editor: Rituximab (RTX) in combination with glucocorticoids has been recommended for relapsing granulomatosis with polyangiitis (GPA) if the disease remains active after a course of cyclophosphamide (CYC) lasting 3–6 months1. We describe a case of perianal Crohn disease (CD) in a patient with GPA who had been treated with RTX. A 24-year-old woman with GPA was diagnosed in 2006 with bilateral cavitating pulmonary lesions on computed tomography, pauciimmune glomerulonephritis with crescents and extraglomerular arteritis on renal biopsy, mononeuritis multiplex, and proteinase 3 (PR3)-antineutrophil cytoplasmic antibodies (ANCA) of > 100 U/ml. Six pulses of CYC with methylprednisolone were administered in 2006, but the patient experienced pulmonary and uveal recurrence of her GPA 5 weeks later. She had 1 course of 2 infusions of RTX (1 g per infusion) in combination with CYC in November 2006 (total cumulative CYC dose 7.5 g). In 2008 she developed headaches secondary to GPA recurrence affecting the pituitary gland confirmed by transsphenoidal biopsy and resulting in … Address correspondence to Dr. S. Boyle, Rheumatology Department, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK. E-mail: boyledoc{at}yahoo.co.uk