Rituximab

Abstract

Lung disease: case report A 65 year-old woman developed lung disease following treatment with rituximab for eosinophilic granulomatosis with polyangiitis. The woman, who had asthma and pulmonary tuberculosis infection, presented due to sudden breathlessness, fever and cough, and subsequently admitted due to respiratory failure on 1 May 2020. She was recently diagnosed with eosinophilic granulomatosis with polyangiitis and received four cycle of rituximab 375 mg/m2 infusion during the hospitalisation with the latest dose on 17 March 2020. At that time, she was discharged on prednisolone. She required ventrimask (five weeks after rituximab infusion) while receiving prednisolone. Her respiratory rate was 22 bpm and pulse rate was 102 bpm. She was normotensive with normothermia. Her lung was found clear on auscultation. Her laboratory testing revealed white cell 12.2 × 109/L with normal eosinophil, platelet count of 233 × 109/L and haemoglobin of 12.1 g/dL. Baseline arterial blood gas testing showed type 1 respiratory failure. A chest X-ray demonstrated bilateral lower lobe reticular opacities and left hilar ground glass opacities. Her HRCT of lung showed scattered intralobular septal thickening along with ground glass opacities in her both lungs, indicative of fibrosis with alveolitis and left upper lobe consolidation. These diagnostic findings were indicating rituximab-induced lung disease. Thus, the woman was treated with hydrocortisone and unspecified antibiotics that led to improvement and subsequent discharge with prescription of prednisolone, calcium and vitamin D tablets. She was in remission six weeks after the discharge.