Central nervous system inflammatory demyelination after rituximab therapy for idiopathic thrombocytopenic purpura.
A 53-year-old female developed unilateral shoulder girdle pain, entire body paresthesiae and imbalance starting 10 days after completing a course of rituximab for chronic idiopathic thrombocytopenic purpura. Neuroimaging studies showed inflammatory demyelinating lesions of the cervical spinal cord and cerebellum. Immunocytochemistry of spinal fluid lymphocytic pleocytosis showed an absolute B cell depletion and a polyclonal/inflammatory T cell response. Intravenous immunoglobulin infusions were associated with clinical and radiological improvements. Anti-CD20-therapy possibly resulted in an imbalance between B cell and T cell populations in the central nervous system, and may have triggered a predominantly cell-mediated immune attack against unidentified nervous system antigens.
Stübgen
Joerg-Patrick
JP
Department of Neurology and Neuroscience, Weill Medical College of Cornell University, New York, NY 10065-4897, USA. pstuebge@med.cornell.edu
D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002493:Central Nervous System Diseases / Q000139:chemically induced* / Q000503:physiopathology; D002908:Chronic Disease; D003711:Demyelinating Diseases / Q000139:chemically induced* / Q000503:physiopathology; D004351:Drug Resistance; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications / Q000188:drug therapy*; D000069283:Rituximab
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D016756:Immunoglobulins, Intravenous; D000069283:Rituximab