title: Plasmapheresis therapy for rare but potentially fatal reaction to rituximab.
abstract: Rituximab (Rituxan), a genetically engineered chimeric murine and human IgG1 monoclonal antibody directed against CD20 antigen, is an emerging drug used for a wide spectrum of disease processes and found to be relatively safe. We report a near-fatal reaction to rituximab, which started 30 min after infusion and worsened over 24 to 48 h, resulting in hemodynamic and respiratory compromise that necessitated both intubation and high-dose vasopressors. Subsequent treatment with plasmapheresis helped stabilize and improve the patient's clinical condition, and the patient was discharged home on hospital day 5. There is no specific treatment for these severe and sometimes fatal reactions except supportive care with plasmapheresis. With the increased use of rituximab therapy in the medical management of numerous diseases, those in the medical community need to be cognizant of the rare fatal or near-fatal infusion reaction and the benefit that may accrue from plasmapheresis therapy.
authors.affiliation: Department of Medicine, Mayo Clinic, Scottsdale, Arizona 85054, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Hastings
authors.forename: Bhavesh
authors.initials: B
authors.lastname: Patel
authors.forename: Antonio Sergio
authors.initials: AS
authors.lastname: Torloni
authors.forename: Farouk
authors.initials: F
authors.lastname: Mookadam
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Betcher
authors.forename: Adyr
authors.initials: A
authors.lastname: Moss
authors.forename: Raymond
authors.initials: R
authors.lastname: Heilman
authors.forename: Marek
authors.initials: M
authors.lastname: Mazur
authors.forename: Khaled
authors.initials: K
authors.lastname: Hamawi
authors.forename: David
authors.initials: D
authors.lastname: Mulligan
authors.forename: Kunam
authors.initials: K
authors.lastname: Reddy
authors.forename: Kristin
authors.initials: K
authors.lastname: Mekeel
authors.forename: Harini
authors.initials: H
authors.lastname: Chakkera
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000506:poisoning*; D058846:Antibodies, Monoclonal, Murine-Derived; D005260:Female; D006402:Hematologic Diseases / Q000139:chemically induced; D006801:Humans; D010956:Plasmapheresis; D011041:Poisoning / Q000628:therapy; D012140:Respiratory Tract Diseases / Q000139:chemically induced; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab