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Lee, Oh, Yoon, Lee, Kim, Kwon, Lee, and Kim: Rituximab-induced Interstitial Pneumonitis in a Young Patient: A Case Report and Review of the Literature
Case Report

Korean J Hematol 2007;42(4):423-427.

Published online: 19 January 2007

DOI: https://doi.org/10.5045/kjh.2007.42.4.423

Rituximab-induced Interstitial Pneumonitis in a Young Patient: A Case Report and Review of the Literature

Dong Mee Lee, M.D., Sung Yong Oh, M.D., Hyun Ah Yoon, M.D., Suee Lee, M.D., Sung-Hyun Kim, M.D., Hyuk-Chan Kwon, M.D., Soo-Keol Lee, M.D., Hyo-Jin Kim, M.D.

Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea

Correspondence to：Hyo-Jin Kim, M.D. Department of Internal Medicine, Dong-A University College of Medicine 1, Dongdaeshin-dong 3-ga, Seo-gu, Busan 602-715, Korea Tel: ＋82-51-240-2951, Fax: ＋82-51-240-2088 E-mail: kimhj@dau.ac.kr

Received 13 September 2007       Revised 23 November 2007       Accepted 26 November 2007

Copyright © 2007 Korean Society of Hematology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Side effects of rituximab are mild in most cases, but there have been a few cases of severe pulmonary toxicity reported in elderly patients. Here we report a case of interstitial pneumonitis following rituximab treatment in a young patient. A 35-year-old woman with diffuse large B-cell lymphoma was admitted complaining of dry cough and dyspnea without fever after the 3 treatments with rituximab-CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy. Her chest CT with high-resolution CT scanning confirmed the presence of bilateral diffuse ground-glass opacities. The analysis of arterial blood gases indicated hypoxemia. The pulmonary function testing showed a restrictive pattern. There were no other findings suggesting an infection. The findings were compatible with a rituximab-induced interstitial pneumonitis. After the patient was treated with prednisolone, the symptoms resolved. Cases with rituximab-induced interstitial pneumonitis develop principally in elderly patients. However, the condition also can occur in young patients.

Keywords: Rituximab, Interstitial pneumonitis, Young patient, Diffuse large B-cell lymphoma

REFERENCES

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Fig. 1
Rituximab-induced interstitial pneumonitis in chest HRCT scan and radiography.
kjh-42-423f1.tif
Fig. 2
After prednisolone treatment for 2 weeks, interstitial pneumonitis resolved in chest HRCT scan and radiography.
kjh-42-423f2.tif
Table 1.
Analysis of arterial blood gases before and afte prednisolone treatment
Parameter Before treatment After treatment
pH 7.449 7.427
pCO2 (mmHg) 38.0 33.0
pO2 (mmHg) 66.4 130.6
O2 saturation (%) 94.0 98.7
Table 2.
Pulmonary function tests before and after prednisolone treatment
Variable Predicted value Before treatment After treatment
FVC (liters) 3.78 1.93 (51%) 3.21 (85%)
FEV1 (liters) 2.98 1.52 (51%) 2.79 (94%)
FEV1/FVC (%) 78 79 87
TLC (liters) 5.30 3.86 (73%) 4.41 (83%)
DLCO (mL/min/mmHg) 21.6 7.0 (33%) 14.1 (65%)

Abbreviations: FVC, forced vital capacity; FEV1, forced expiratory volume in one second; TLC, total lung capacity; DLCO, carbon monoxide diffusing capacity.

Table 3.
Patients’ characteristics of reported cases
Case Year Sex Age Diagnosis
Kanelli et al. (10) 2001 Male 56 MCL
Burton et al. (7) 2003 Male 69 NHL
Alexandrescu et al. (11) ) 2004 Male 65 DLBCL
Hiraga et al. (12) 2005 Male 80 DLBCL
Choi et al. (13) 2006 Female 67 DLBCL
Lee et al. (14) 2006 Male 73 DLBCL
    Male 66 DLBCL
This report 2007 Female 35 DLBCL

Abbreviations: MCL, mantle cell lymphoma; DLBCL, diffuse large B cell lymphoma; NHL, non-Hodgkin lymphoma.

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