Rituximab-induced serum sickness in a patient with refractory chronic immune thrombocytopenic purpura: a case report and review of the literature
Abstract
Abstract
Although common side effects such as fever, chills and rigors are commonly seen during the first infusion of rituximab; delayed ones such as serum sickness and Steven-Johnson syndrome have rarely been reported. We report an adult patient with steroid resistant and splenectomized chronic immune thrombocytopenic purpura who presented with fever, arthralgia, asthma like respiratory symptoms, maculopapular rash, and palpable purpuric lesions 2 days after the third infusion of rituximab. Withdrawal of rituximab and subsequent treatment with i.v. steroid and antihistaminics improved the patient’s clinical and physical findings. In such cases rituximab should be discontinued, complete and rapid resolution can be possible with systemic steroid treatment.
Keywords: Rituximab, chronic immune thrombocytopenic purpura, CD20, serum sickness, intravenous immunoglobulin
Özet
Ateş, titreme ve kasılma gibi yan etkiler ilk kez yapılan rituksimab infüzyonu sırasında sıkça görülmesine karşılık, serum hastalığı ve Steven-Johnson sendromu gibi gecikmiş yan etkiler nadir olarak bildirilmiştir. Steroide dirençli ve splenektomize kronik immün trombositopenili bir hasta, üçüncü rituksimab infüzyonundan iki gün sonra ateş, artralji, astım benzeri solunum sistemi semptomları, makülopapüler raş ve palpabl purpurik lezyonlar ile başvurdu. Rituksimabın kesilmesi, sonrasında intravenöz steroid ve antihistaminik tedavi uygulanması ile hastanın kliniği ve fiziki bulguları düzeldi. Bu gibi vakalarda rituksimabın kesilmesi ve sistemik steroid tedavi uygulanması ile tam ve hızlı bir düzelme sağlanabileceğini düşünmekteyiz.
Anahtar sözcükler: Rituksimab, kronik immün trombositopenik purpura, CD20, serum hastalığı, intravenöz immunoglobulin
Keywords
References
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Details
Primary Language
English
Subjects
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Journal Section
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Publication Date
June 20, 2011
Submission Date
July 25, 2010
Acceptance Date
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Published in Issue
Year 2011 Volume: 33 Number: 2