title: Acute jugular vein thrombosis during rituximab administration: Review of the literature.
abstract: Rituximab, a chimeric monoclonal antibody is licensed for the treatment of CD20 positive lymphomas. Previous studies have found rituximab, in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy, is superior to cyclophosphamide, doxorubicin, vincristine, and prednisone alone in the treatment of diffuse large B-cell lymphoma and many other B-cell lymphomas. Acute hypersensitivity reactions have been reported in patients receiving rituximab infusion and usually manifesting as headache, fever, chills, sweats, skin rash, dyspnea, mild hypotension, and nausea. Acute major venous thrombosis and seizures have not been reported as manifestation of acute hypersensitivity reaction. We report on a 22-year-old woman, who was diagnosed with stage III B CD20 positive B-cell diffuse large B-cell lymphoma. During the first cycle of treatment, she developed grand-mal seizure while receiving rituximab infusion without any other features of acute hypersensitivity reaction. Imaging confirmed new onset jugular vein thrombosis with normal coagulation parameters. These events were managed by anticonvulsants and anticoagulation therapy. The patient completed eight cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone without rituximab and achieved complete remission. No further complications were noted. To our knowledge, this is the first case in the literature describing grand-mal seizures and acute thrombosis while on rituximab treatment. Clinicians should be aware of this rare side effect, as stopping rituximab can prevent recurrence of these complications.
authors: Department of Oncology MBC J-64, King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia College of Medicine, Al-Faisal University, Riyadh, Kingdom of Saudi Arabia rdada@kfshrc.edu.sa.
authors: Reyad
authors: R
authors: Dada
authors: Department of Oncology MBC J-64, King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia College of Medicine, Al-Faisal University, Riyadh, Kingdom of Saudi Arabia.
authors: Jamal
authors: J
authors: Zekri
authors: Department of Oncology MBC J-64, King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia.
authors: Bilal
authors: B
authors: Ramal
authors: Department of Oncology MBC J-64, King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia Oncology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors: Kamel
authors: K
authors: Ahmad
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy; D000069283:Rituximab / Q000009:adverse effects* / Q000627:therapeutic use; D013927:Thrombosis / Q000139:chemically induced*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D000069283:Rituximab
keywords: Rituximab; anti-CD20; non-Hodgkin lymphoma; thrombosis