[Interstitial pneumonitis as a side effect of rituximab].
A 42-year-old man with large B-cell non-Hodgkin lymphoma was admitted to hospital after eight chemotherapy cycles of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP). He had high fever, non-productive cough, dyspnoea, and on chest X-ray, interstitial infiltrations. Extensive microbiological investigation excluded any infection, including opportunistic infection. Positron emission tomography (PET) scan was negative at previous lymphoma sites, but showed diffuse fluorodeoxyglucose uptake in both lungs. Pulmonary function testing demonstrated a restrictive pattern and a diffusion deficit. Review of the literature showed that this clinical picture closely corresponded with that of rituximab-induced interstitial pneumonitis. Treatment with prednisolone, 40 mg/day, resulted in a fast and complete recovery. Physicians administering rituximab should be aware of rituximab-induced interstitial pneumonitis, since according to recent literature this condition occurs in 9-14% of patients. It can run a mild course, but can also be fatal. Besides stopping rituximab, most patients need corticosteroid therapy.
Kemming
J L Hans
JL
Ziekenhuis Rijnstate, afd. Interne Geneeskunde, Arnhem, The Netherlands. hkemming@alysis.nl
van Zeeland
Roel E P
RE
Ullmann
Eric F
EF
Mattijssen
E J M Vera
EJ
D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000139:chemically induced* / Q000188:drug therapy; D016393:Lymphoma, B-Cell / Q000188:drug therapy; D008297:Male; D049268:Positron-Emission Tomography; D011241:Prednisone / Q000627:therapeutic use*; D012129:Respiratory Function Tests; D000069283:Rituximab
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D005938:Glucocorticoids; D000069283:Rituximab; D011241:Prednisone