[Use of rituximab in the induction of remission of severe, resistant and recurrent form of polyangiitis associated with c-ANCA antibodies - case report].
Indications for rituximab (RTX) have recently widened. We present a case of 25-years old patient with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis of high disease activity. The patient in severe condition, massive changes of nasal sinuses, with destruction of the orbit bones, with inflammatory infiltrations of the optical nerves and end stage renal disease was admitted to Nephrology Clinic to begin renal replacement therapy (RRT). Chest HRCT reveled changes of "frosted glass", enlarged mediastinal lymphatic nodes and fluid in pleural cavities. C-ANCA antibodies was 23 IU/ml (norm: <2IU/ml). Due to the lack of therapeutic possibilities (exceeded cumulative dose of cyclophosfamide, recurrence of the disease during treatment with mycophenolate mofetil) rituximab was introduced. After proving high expression of CD 20 antigen on the surface of B lymphocytes, two doses of rituximab were administrated (1,0g every two weeks). 8 weeks after the second dose remission of lungs disorders was observed, c- ANCA level decreased to 3,7IU/ml and the granulomatous mass around the optical nerve was stable. 12 months later another supporting dose of rituximab was administrated. Now, 18 months after relapse of the disease patient is in good condition waiting for kidney transplantation. Rituximab is save, well tolerated and effective. Particularly high efficiency of RTX have been observed against lung disorders. No significant remission of granuloma infiltration in the orbits has been noted. Better evaluation of efficiency and safety of rituximab needs further evaluation.
Military Institute of Medicine in Warsaw, Poland, Central Clinical Hospital of the Ministry of National Defense, Department of Internal Diseases, Nephrology and Dialysis.
Dorota
D
Brodowska-Kania
Military Institute of Medicine in Warsaw, Poland, Central Clinical Hospital of the Ministry of National Defense, Department of Internal Diseases, Nephrology and Dialysis.
Aleksandra
A
Rymarz
Military Institute of Medicine in Warsaw, Poland, Central Clinical Hospital of the Ministry of National Defense, Department of Internal Diseases, Nephrology and Dialysis.
Marek
M
Saracyn
Military Institute of Medicine in Warsaw, Poland, Central Clinical Hospital of the Ministry of National Defense, Department of Internal Diseases, Nephrology and Dialysis.
Piotr
P
Geisler
Military Institute of Medicine in Warsaw, Poland, Central Clinical Hospital of the Ministry of National Defense, Department of Internal Diseases, Nephrology and Dialysis.
StanisŁaw
S
Niemczyk
D000328:Adult; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000188:drug therapy*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D012008:Recurrence; D012074:Remission Induction; D000069283:Rituximab
D058846:Antibodies, Monoclonal, Murine-Derived; D007166:Immunosuppressive Agents; D000069283:Rituximab
anti-CD20 monoclonal antibody; anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis; rituximab