title: [Successful treatment with rituximab for type III cryoglobulinemia].
abstract: A 71-year-old man with rheumatoid arthritis was referred to our hospital with complaints of face and leg edema and was admitted for management of acute renal failure. Type III cryoglobulinemia was diagnosed based on histopathological findings of a kidney biopsy which revealed cryoglobulinemic nephropathy. Immunofixation showed no serum M-proteins. Steroid pulse and apheresis were initiated but the proteinuria did not improve. Rituximab was administered four times weekly as a second-line treatment, eliminating the proteinuria, after which the steroid dose was gradually tapered until discontinuation. No recurrence of proteinuria was observed more than 1 year after termination of rituximab therapy. This suggests that rituximab exerts a long-term effect. Although this patient developed candidiasis during rituximab therapy, the therapy could be continued as the antifungal agents prevented exacerbation of the infection. Rituximab can be used for the treatment of steroid-refractory cryoglobulinemia. However, clinicians should remain aware of possible infections associated with immunosuppression.
authors.affiliation: Department of Hematology, Yamaguchi Grand Medical Center.
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Suehiro
authors.forename: Aki
authors.initials: A
authors.lastname: Ishido
authors.forename: Toru
authors.initials: T
authors.lastname: Shigeoka
authors.forename: Takayuki
authors.initials: T
authors.lastname: Tominaga
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Korenaga
authors.forename: Mitsutaka
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Toru
authors.initials: T
authors.lastname: Takahashi
mesh_terms: D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications; D003449:Cryoglobulinemia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D008297:Male; D012008:Recurrence; D012074:Remission Induction; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab