title: Development of serum sickness-like symptoms after rituximab infusion in two patients with severe hypergammaglobulinemia.
abstract: Rituximab is a monoclonal antibody that depletes B cells and is commonly used for the treatment of autoimmune diseases. In this report, we describe 2 patients with autoimmune diseases and marked hypergammaglobulinemia attending at a tertiary care hospital, who, following treatment with rituximab, developed a severe serum-sickness-like reactions. Both patients were treated with intravenous corticosteroids, recovered well, and on follow-up, were negative for the development of human antichimeric antibodies. Based on these and other similar cases in the literature, we propose that severe hypergammaglobulinemia due to autoimmune conditions may be a predisposing factor for the development of a serum sickness-like reaction after treatment with Rituximab, which can sometimes occur without prior exposure to this antibody. Rheumatologists should be aware of this possible association when prescribing this medication.
authors.affiliation: Hospital Israelita Albert Einstein and Albert Einstein Research Institute, São Paulo, Brazil, CEP 05652-900. ascklepius@gmail.com
authors.forename: Eduardo
authors.initials: E
authors.lastname: Finger
authors.forename: Morton
authors.initials: M
authors.lastname: Scheinberg
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006942:Hypergammaglobulinemia / Q000188:drug therapy*; D008875:Middle Aged; D000069283:Rituximab; D012713:Serum Sickness / Q000139:chemically induced*; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D000069283:Rituximab