Plasmapheresis therapy for rare but potentially fatal reaction to rituximab.
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.
Hastings
Deborah
D
Department of Medicine, Mayo Clinic, Scottsdale, Arizona 85054, USA.
Patel
Bhavesh
B
Torloni
Antonio Sergio
AS
Mookadam
Farouk
F
Betcher
Jeffrey
J
Moss
Adyr
A
Heilman
Raymond
R
Mazur
Marek
M
Hamawi
Khaled
K
Mulligan
David
D
Reddy
Kunam
K
Mekeel
Kristin
K
Chakkera
Harini
H
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
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab