Anti-glomerular basement membrane antibody disease treated with rituximab: A case-based review.
OBJECTIVE
To report the successful use of rituximab in a patient with anti- glomerular basement membrane (GBM) antibody disease and to review the literature regarding rituximab use in anti-GBM mediated disease.


METHODS
We report a case of anti-GBM antibody disease with both anti-GBM antibodies and anti-myeloperoxidase (MPO) specific p-ANCA, who developed thrombotic thrombocytopenic purpura (TTP) on high dose prednisone, plasmapheresis, and cyclophosphamide therapy. The patient was then treated with rituximab. We analyzed the clinical features of five additional patients of anti-GBM disease treated with rituximab identified through a systematic literature review.


RESULTS
Our patient was 68-year-old female who presented with acute renal failure. Renal biopsy showed crescentic glomerulonephritis with linear deposits of IgG antibody along the glomerular basement membrane. Treatment was initiated with high dose prednisone, plasmapheresis and oral cyclophosphamide, with subsequent development of leukopenia and TTP and discontinuance of cyclophosphamide. Treatment with rituximab was initiated with clinical improvement of her hematological parameters but not her renal function. Among the five previously reported cases of anti-GBM disease treated with rituximab, three received brief course of IV cyclophosphamide prior to use of rituximab. Except one patient, all recovered renal function and remained dialysis independent. The anti-GBM antibody level remained undetected in all patients.


CONCLUSIONS
Combination of prednisone, plasmapheresis, and rituximab can be an effective therapy in patients with an anti-GBM antibody disease complicated with TTP.
Department of Medicine, Division of Rheumatology, Case Western Reserve University/MetroHealth Medical Center, Cleveland, OH 44109, USA.
Uzma A
UA
Syeda
Nora G
NG
Singer
Marina
M
Magrey
D000368:Aged; D019867:Anti-Glomerular Basement Membrane Disease / Q000188:drug therapy / Q000276:immunology / Q000628:therapy*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D001323:Autoantibodies / Q000276:immunology; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007678:Kidney Glomerulus / Q000276:immunology; D010956:Plasmapheresis; D011241:Prednisone / Q000627:therapeutic use; D000069283:Rituximab; D016896:Treatment Outcome
D058846:Antibodies, Monoclonal, Murine-Derived; D001323:Autoantibodies; D007166:Immunosuppressive Agents; C051951:antiglomerular basement membrane antibody; D000069283:Rituximab; D003520:Cyclophosphamide; D011241:Prednisone