Rituximab Induced Interstitial Lung Disease Diagnosis, Treatment Outcome, and Risk’s Factor, a Place for Transbronchial Pulmonary Cryobiopsy

Douze Makenzi,Jossart Adrien,Praile Martin,Mond Victoria,Maeck Patricia,Klipper Dit Kurtz Noemie,Vintila Sabina,Makhoul Martin

doi:10.4236/crcm.2021.1010036

Abstract

Rituximab (RTX) is a mouse/human chimeric anti-CD20 IgG1 monoclonal antibody, approved in late 1998 by the FDA. Effectively used as a single agent or combined with a chemotherapy regimen to treat lymphoma, RTX is a significant step forward in the arsenal treatment of idiopathic thrombocytopenic purpura, systemic lupus erythematous, rheumatoid arthritis, and autoimmune hemolytic anemia. Side effects of RTX are commonly seen during the first infusion in up to 50% of patients and include fever, chills, and rigors. These side effects are generally transient and related to the tumor burden, probably due to a greater degree of complement activation and proinflammatory cytokine release. Severe lung toxicity like cryptogenic organizing pneumonia, pneumonitis, and interstitial lung diseases are infrequent, with most of the knowledge coming from case reports.

Highlights

IntroductionA 67-year-old male Caucasian patient presented at the emergency department with a history of progressive dyspnea, fever, and dry cough
Severe lung toxicity like cryptogenic organizing pneumonia, pneumonitis, and interstitial lung diseases are infrequent, with most of the knowledge coming from case reports
The objective of this article is to peculiarize the syndrome of rituximab-induced interstitial lung disease (R-ILD)

Summary

Introduction

A 67-year-old male Caucasian patient presented at the emergency department with a history of progressive dyspnea, fever, and dry cough. Two weeks before the onset of his symptoms, he received his second dose of rituximab (RTX-based regimen of 1 g followed 14 days later of another 1 g dose) in the setting of a P-ANCA granulomatosis with polyangiitis diagnoses by renal biopsy. At the beginning of his condition, the patient presented with isolated renal involvement such as acute kidney injury, strong sediment hematuria, and nephrotic syndrome, 3.5 g/24 hr. His initial vital signs were as follows: temperature 36.9 ̊C, with a heart rate of 90 beats/min, blood pressure 140/80 mmHg, tachypnea with a respiratory rate of 20/min and oxygen saturation 86% on room air, 91% with 3 L of O2 within a nasal canula. Physical examination was unremarkable except for bilateral scattered inspiratory crackles

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