title: Rituximab induces resolution of recurrent diffuse alveolar hemorrhage in a patient with primary antiphospholipid antibody syndrome.
abstract: Diffuse alveolar hemorrhage (DAH) is a rare manifestation of primary antiphospholipid antibody syndrome (APS). We describe a patient with primary APS and refractory recurrent episodes of DAH. The patient was admitted 15 times due to recurrent episodes of DAH in a period of 18 months. Multiple immunosuppressive drugs did not improve his condition. Two years after his presentation, he was treated with rituximab (two doses of 1 g, 2 weeks apart). Six months later, the attacks of DAH have gradually disappeared. In a follow-up of more than 2 years after he received rituximab, the patient has had no further admissions due to DAH. Levels of antiphospholipid antibodies were measured during follow-up of 4 years. Anti-β2 glycoprotein IgG titer decreased to normal 6 months after therapy but anticardiolipin (aCL) antibody titer increased. We conclude that rituximab caused a dramatic clinical response in this patient. Anti-β2 glycoprotein IgG correlated better with the clinical response in this patient than aCL.
authors: Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. anatscheiman@yahoo.com
authors: A
authors: A
authors: Scheiman Elazary
authors: P P
authors: PP
authors: Klahr
authors: A Y
authors: AY
authors: Hershko
authors: Z
authors: Z
authors: Dranitzki
authors: A
authors: A
authors: Rubinow
authors: Y
authors: Y
authors: Naparstek
mesh_terms: D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers / Q000097:blood; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D008171:Lung Diseases / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D012008:Recurrence; D000069283:Rituximab; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D001323:Autoantibodies; D015415:Biomarkers; D007155:Immunologic Factors; D000069283:Rituximab