Abstract
A 46-year-old woman, who had suffered from Sjogren syndrome for over 25 years, developed an extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue of her right parotic gland. She was treated with monotherapy rituximab, 375 mg/m weekly with premedication consisting of 1000 mg paracetamol, 1 mg clemastin and 25 mg prednisolone. Two days after the second course of rituximab, she developed severe arthralgia of multiple joints. After a further 2 d, she had progressive skin lesions of her legs that were clinically suggestive of vasculitis (top, bottom). Her temperature was 38 C. Laboratory investigations showed normal values for blood count and creatinine. A diagnosis of serum sickness was made. A short course of prednisone 20 mg/d was given and the symptoms resolved over the next 5 d. Serum sickness is a type III hypersensitivity reaction resulting from the injection of foreign protein and subsequent formation of antibodies, occurring 4–10 after exposure. Clinical symptoms can include fever, arthralgia, lymphadenopathy and skin eruptions. Serum sickness caused by rituximab has been reported, but is uncommon.
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