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
- Bussel J, Cines DB. Immune thrombocytopenic purpura, neonatal alloimmune thrombocytopenia, and posttransfusion purpura. In: Hoffman R, Benz Jr EJ, Shattil S, Furie B, Silberstein LE, McGlave P, Heslop H, Anastazi J (Eds). Hematology Basic Principles and Practice. 5th ed. Churchill Livingtone, Elsevier 2009; pp 2083-97.
- Vianelli N, Galli M, de Vivo A, Intermesoli T, Giannini B, Mazzucconi MG, Barbui T, Tura S, Baccaranion M; Gruppo Italiano per lo Studio delle Malattie Ematologiche dell'Adulto. Efficacy and safety of splenectomy in immune thrombocytopenic purpura: longterm results of 402 cases. Haematologica 2005; 90: 72-7.
- Wang J, Wiley JM, Luddy R, Greenberg J, Feuerstein MA, Bussel JB. Chronic immune thrombocytopenic purpura in children: assessment of rituximab treatment. J Pediatr 2005; 146: 217-21.
- Winkler U, Jensen M, Manzke O, Schulz H, Diehl V, Engert A. Cytokine-release syndrome in patients with B-cell chronic lymphocytic leukemia and high lymphocyte counts after treatment with an anti-CD20 monoclonal antibody (rituximab, IDEC-C2B8). Blood 1999; 94: 2217-24.
- Goto S, Goto H, Tanoshima R, Kato H, Takahashi H, Sekiguchi O, Kai S. Serum sickness with an elevated level of human anti-chimeric antibody following treatment with rituximab in a child with chronic immune thrombocytopenic purpura. Int J Hematol 2009; 89: 305-9.
- Finger E, Scheinberg M. Development of serum sickness-like symptoms after rituximab infusion in two patients with severe hypergammaglobulinemia. J Clin Rheumatol 2007; 13: 94-5.
- Cheifetz A, Mayer L. Monoclonal antibodies, immunogenecity, and associated infusion reactions. Mt Sinai J Med 2005; 72: 250-6.
- Bennett CM, Rogers ZR, Kinnamon DD, Bussel JB, Mahoney DH, Abshire TC, Sawaf H, Moore TB, Loh ML, Glader BE, McCarthy MC, Mueller BU, Olson TA, Lorenzana AN, Mentzer WC, Buchanan GR, Feldman HA, Neufeld EJ. Prospective phase 1/2 study of rituximab in childhood and adolescent chronic immune thrombocytopenic purpura. Blood 2006; 107: 2639-42.
- Tonelli AR, Lottenberg R, Allan RW, Sriram PS. Rituximab-induced hypersensitivity pneumonitis. Respiration 2009; 78: 225-9.
- Hellerstedt B, Ahmed A. Delayed-type hypersensitivity reaction or serum sickness after rituximab treatment. Ann Oncol 2003; 14: 1792.
- Doan T, Massarotti E. Rituximab. Drugs Today 2005; 41: 785-97.
- van der Kolk LE, Grillo-Lopez AJ, Baars JW, Hack CE, van Oers MH. Complement activation plays a key role in the side-effects of rituximab treatment. Br J Haematol 2001; 115: 807-11.
- Davis TA, Grillo-López AJ, White CA, McLaughlin P, Czuczman MS, Link BK, Maloney DG, Weaver RL, Rosenberg J, Levy R. Rituximab anti-CD 20 monoclonal antibody therapy in non-Hodgkin’s lymphoma: safety and efficacy of re-treatment. J Clin Oncol 2000; 18: 3135-43.
- Todd DJ, Helfgott SM. Serum sickness following treatment with rituximab. J Rheumatol 2007; 34: 430-3.
- Medeot M, Zaja F, Vianelli N, Battista M, Baccarani M, Patriarca F, Soldano F, Isola M, De Luca S, Fanin R. Rituximab therapy in adult patients with relapsed or refractory immune thrombocytopenic purpura: long-term follow-up results. Eur J Haematol 2008; 81: 165-9.
- Catuogno M, Rezai S, Priori R, Magrini L, Valesini G. Serum sickness associated with rituximab in a patient with hepatitis C virus-related mixed cryoglobulinaemia. Rheumatology (Oxford) 2005; 44: 406.
- Lowndes S, Darby A, Mead G, Lister A. Steven-Johnson syndrome after treatment with rituximab. Ann Oncol 2002; 13: 1948-50.
Refrakter kronik immün trombositopenili bir hastada rituksimab ilişkili serum hastalığı: bir vaka raporu ve literatürün gözden geçirilmesi
Abstract
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
Keywords
Rituksimab kronik immün trombositopenik purpura CD20 serum hastalığı intravenöz immunoglobulin
References
- Bussel J, Cines DB. Immune thrombocytopenic purpura, neonatal alloimmune thrombocytopenia, and posttransfusion purpura. In: Hoffman R, Benz Jr EJ, Shattil S, Furie B, Silberstein LE, McGlave P, Heslop H, Anastazi J (Eds). Hematology Basic Principles and Practice. 5th ed. Churchill Livingtone, Elsevier 2009; pp 2083-97.
- Vianelli N, Galli M, de Vivo A, Intermesoli T, Giannini B, Mazzucconi MG, Barbui T, Tura S, Baccaranion M; Gruppo Italiano per lo Studio delle Malattie Ematologiche dell'Adulto. Efficacy and safety of splenectomy in immune thrombocytopenic purpura: longterm results of 402 cases. Haematologica 2005; 90: 72-7.
- Wang J, Wiley JM, Luddy R, Greenberg J, Feuerstein MA, Bussel JB. Chronic immune thrombocytopenic purpura in children: assessment of rituximab treatment. J Pediatr 2005; 146: 217-21.
- Winkler U, Jensen M, Manzke O, Schulz H, Diehl V, Engert A. Cytokine-release syndrome in patients with B-cell chronic lymphocytic leukemia and high lymphocyte counts after treatment with an anti-CD20 monoclonal antibody (rituximab, IDEC-C2B8). Blood 1999; 94: 2217-24.
- Goto S, Goto H, Tanoshima R, Kato H, Takahashi H, Sekiguchi O, Kai S. Serum sickness with an elevated level of human anti-chimeric antibody following treatment with rituximab in a child with chronic immune thrombocytopenic purpura. Int J Hematol 2009; 89: 305-9.
- Finger E, Scheinberg M. Development of serum sickness-like symptoms after rituximab infusion in two patients with severe hypergammaglobulinemia. J Clin Rheumatol 2007; 13: 94-5.
- Cheifetz A, Mayer L. Monoclonal antibodies, immunogenecity, and associated infusion reactions. Mt Sinai J Med 2005; 72: 250-6.
- Bennett CM, Rogers ZR, Kinnamon DD, Bussel JB, Mahoney DH, Abshire TC, Sawaf H, Moore TB, Loh ML, Glader BE, McCarthy MC, Mueller BU, Olson TA, Lorenzana AN, Mentzer WC, Buchanan GR, Feldman HA, Neufeld EJ. Prospective phase 1/2 study of rituximab in childhood and adolescent chronic immune thrombocytopenic purpura. Blood 2006; 107: 2639-42.
- Tonelli AR, Lottenberg R, Allan RW, Sriram PS. Rituximab-induced hypersensitivity pneumonitis. Respiration 2009; 78: 225-9.
- Hellerstedt B, Ahmed A. Delayed-type hypersensitivity reaction or serum sickness after rituximab treatment. Ann Oncol 2003; 14: 1792.
- Doan T, Massarotti E. Rituximab. Drugs Today 2005; 41: 785-97.
- van der Kolk LE, Grillo-Lopez AJ, Baars JW, Hack CE, van Oers MH. Complement activation plays a key role in the side-effects of rituximab treatment. Br J Haematol 2001; 115: 807-11.
- Davis TA, Grillo-López AJ, White CA, McLaughlin P, Czuczman MS, Link BK, Maloney DG, Weaver RL, Rosenberg J, Levy R. Rituximab anti-CD 20 monoclonal antibody therapy in non-Hodgkin’s lymphoma: safety and efficacy of re-treatment. J Clin Oncol 2000; 18: 3135-43.
- Todd DJ, Helfgott SM. Serum sickness following treatment with rituximab. J Rheumatol 2007; 34: 430-3.
- Medeot M, Zaja F, Vianelli N, Battista M, Baccarani M, Patriarca F, Soldano F, Isola M, De Luca S, Fanin R. Rituximab therapy in adult patients with relapsed or refractory immune thrombocytopenic purpura: long-term follow-up results. Eur J Haematol 2008; 81: 165-9.
- Catuogno M, Rezai S, Priori R, Magrini L, Valesini G. Serum sickness associated with rituximab in a patient with hepatitis C virus-related mixed cryoglobulinaemia. Rheumatology (Oxford) 2005; 44: 406.
- Lowndes S, Darby A, Mead G, Lister A. Steven-Johnson syndrome after treatment with rituximab. Ann Oncol 2002; 13: 1948-50.
Details
| Primary Language | English |
|---|---|
| Journal Section | Case Reports |
| Authors | |
| Publication Date | June 20, 2011 |
| Published in Issue | Year 2011Volume: 33 Issue: 2 |