Fatal rituximab-associated lung injury syndrome in a patient treated with rituximab for recurrence of post-transplant nephrotic syndrome.
Rituximab (anti-B CD20 ab.) in recently widely used in renal transplantation.


METHODS
A 10-yr-old patient with end-stage renal failure due to multidrug-resistant NS was transplanted with renal graft from deceased donor and presented immediate recurrence of NS. PF was started on day 3 and patient received MP pulses, however with no effect. Rituximab (4 × 375 mg/m(2)) was administered. Chest radiographs taken at that time were normal. Partial remission was achieved and the patient was discharged in good condition. Sequential recurrence appeared two wk afterward. Twelve sessions of PF were performed and six pulses of MP were given, effecting a partial remission. Three months after the last dose of rituximab, patient was admitted with increasing respiratory failure, requiring mechanical ventilation. Infectious background, including CMV, BKV, mycoplasma, and pneumocystis, was not confirmed. The patient was treated with MP pulses, IVIG, and a variety of antibiotics. Ground-glass opacity was confirmed on lung CT images. Respiratory failure worsened, despite aggressive ventilation and patient passed away after three wk at ICU. A destruction of alveolar epithelium and extended pulmonary fibrosis was confirmed in the autopsy report. The case represents a fatal RALI.
Department of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland.
Ryszard
R
Grenda
Department of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland.
Wioletta
W
Jarmużek
Department of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland.
Jacek
J
Rubik
Intensive Care Unit, Department of Anesthesiology and Intensive Care, The Children's Memorial Health Institute, Warsaw, Poland.
Marek
M
Migdał
Department of Pathology, The Children's Memorial Health Institute, Warsaw, Poland.
Maciej
M
Pronicki
D002648:Child; D017809:Fatal Outcome; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects; D008168:Lung / Q000187:drug effects*; D055370:Lung Injury / Q000139:chemically induced* / Q000150:complications; D009404:Nephrotic Syndrome / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications; D011658:Pulmonary Fibrosis / Q000209:etiology; D012008:Recurrence; D012074:Remission Induction; D000069283:Rituximab / Q000009:adverse effects*
D000069283:Rituximab
rituximab; rituximab-associated lung injury; transplantation