title: A case of refractory vasculitic ulcers in a systemic lupus erythematosus patient responding to rituximab and hyperbaric oxygen therapy.
abstract: Large refractory vasculitic ulcers are not commonly seen in systemic lupus erythematosus (SLE) patients. We report a case of refractory vasculitic ulcers responding to rituximab, a monoclonal antibody directed against CD20 cells leading to prolonged B cell depletion. This treatment was initiated after treatment with high-dose steroids and other immunosuppressants were ineffective/associated with significant side-effects. Following treatment with rituximab, there was sustained clinical improvement and subsequent reduction of prednisolone dose. Rituximab was well-tolerated. Concomitant methotrexate therapy and hyperbaric oxygen therapy (HBOT) may have aided the recovery of the patient's vasculitic ulcers. This case and anecdotal reports have illustrated the efficacy and safety of rituximab in the treatment of refractory SLE-related vasculitic ulcers. Further studies to determine the long-term efficacy and side-effects would be useful.
authors.affiliation: Department of Rheumatology and Immunology, Singapore General Hospital, Singapore. lui.nai.lee@singhealth.com.sg
authors.forename: Nai-Lee
authors.initials: NL
authors.lastname: Lui
authors.forename: Julian
authors.initials: J
authors.lastname: Thumboo
authors.forename: Kok-Yong
authors.initials: KY
authors.lastname: Fong
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D007155:Immunologic Factors / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007871:Leg Ulcer / Q000150:complications / Q000473:pathology* / Q000628:therapy; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000473:pathology* / Q000628:therapy; D008727:Methotrexate / Q000627:therapeutic use; D011239:Prednisolone / Q000627:therapeutic use; D000069283:Rituximab; D016896:Treatment Outcome; D014657:Vasculitis / Q000150:complications / Q000473:pathology* / Q000628:therapy
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D000069283:Rituximab; D011239:Prednisolone; D008727:Methotrexate