title: Refractory antineutrophil cytoplasmic antibody-associated vasculitis successfully treated with rituximab: a case report.
abstract: A 63-year-old-man was diagnosed in March 2002 with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis because of mononeuritis multiplex, interstitial pneumonia and a positive finding for myeloperoxidase (MPO)-ANCA. Although treated with prednisolone and oral cyclophosphamide, he suffered repeated remission and deterioration of his conditon, which was complicated by hypertrophic pachymeningitis and sinusitis. In July 2006, he was diagnosed with an exacerbation of ANCA-associated vasculitis because of pyrexia, general malaise, numbness in his face and legs, and elevated serum CRP level. Steroid pulse therapy was thus initiated and the patient's clinical symptoms improved. However, serum CRP levels elevated again (5.18 mg/dl) in September 2006. We began administration of rituximab (500 mg/bodyx4 times) in November 2006 and his symptom and laboratory data significantly improved. The dose of prednisolone was slowly decreased without suffering a relapse. Rituximab has been administered every one year, and good disease control has been achieved. Diagnosis of Wegener's granulomatosis was made from the findings of a nodular lesion in the left lung. Rituximab should be considered for patients with refractory ANCA-associated vasculitis.
authors.affiliation: Department of Internal Medicine and Rheumatology, Clinical Research Center, National Hospital Organization, Kyushu Medical Center.
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Horai
authors.forename: Tomoya
authors.initials: T
authors.lastname: Miyamura
authors.forename: Soichiro
authors.initials: S
authors.lastname: Takahama
authors.forename: Akie
authors.initials: A
authors.lastname: Hirata
authors.forename: Masataka
authors.initials: M
authors.lastname: Nakamura
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ando
authors.forename: Rumi
authors.initials: R
authors.lastname: Minami
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Eiichi
authors.initials: E
authors.lastname: Suematsu
mesh_terms: D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D058846:Antibodies, Monoclonal, Murine-Derived; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein; D003520:Cyclophosphamide / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D014890:Granulomatosis with Polyangiitis / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D012008:Recurrence; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D015415:Biomarkers; D000069283:Rituximab; D003520:Cyclophosphamide; D002097:C-Reactive Protein; D011239:Prednisolone