Journal List > Korean J Hematol > v.42(4) > 1032756

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

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.

REFERENCES

1). Maloney DG., Smith B., Rose A. Rithuximab: mechanism of action and resistance. Semin Oncol. 2002. 29(2 Suppl):2–9.
2). Coiffier B. Rituximab therapy in malignant lymphoma. Oncogene. 2007. 26:3603–13.
crossref
3). Dass S., Vital EM., Emery P. Rituximab: novel B-cell depletion therapy for the treatment of rheumatoid arthritis. Expert Opin Pharmacother. 2006. 7:2559–70.
crossref
4). Coiffier B., Lepage E., Brière J, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med. 2002. 346:235–42.
crossref
5). Enomoto T., Usuki J., Azuma A., Nakagawa T., Kudoh S. Diabetes mellitus may increase risk for idiopathic pulmonary fibrosis. Chest. 2003. 123:2007–11.
6). Limper AH. Drug-induced pulmonary disease. In: Mason RJ, Murray JF, Broaddus VC, Nadel JA, eds. 4th ed.Text book of respiratory medicine. Philadelphia: Elsevier Saunders;2005. p. 611–24.
7). Burton C., Kaczmarski R., Jan-Mohamed R. Interstitial pneumonitis related to rituximab therapy. N Engl J Med. 2003. 348:2690–1.
crossref
8). Herishanu Y., Polliack A., Leider-Trejo L., Grieff Y., Metser U., Naparstek E. Fatal interstitial pneumonitis related to rituximab-containing regimen. Clin Lymphoma Myeloma. 2006. 6:407–9.
crossref
9). Bienvenu J., Chvetzoff R., Salles G, et al. Tumor necrosis factor alpha release is a major biological event associated with rituximab treatment. Hematol J. 2001. 2:378–84.
10). Kanelli S., Ansell SM., Habermann TM., Inwards DJ., Tuinstra N., Witzig TE. Rituximab toxicity in patients with peripheral blood mailgnant B-cell lymphocytosis. Leuk Lymphoma. 2001. 42:1329–37.
11). Alexandrescu DT., Dutcher JP., O'Boyle K., Albulak M., Oiseth S., Wiernik PH. Fatal intra-alveloar hemorrhage after rituximab in a patient with non-Hodg-kin's lymphoma. Leuk Lymphoma. 2004. 45:2321–5.
12). Hiraga J., Kondoh Y., Taniguchi H., Kinoshita T., Naoe T. A case of interstitial pneumonia induced by rithuximab therapy. Int J Hematol. 2005. 81:169–70.
13). Choi YJ., Jung WJ., Oh SI, et al. A case of interstitial lung diseasec caused by Rituximab in non-Hodgkin lymphoma. Korean J Med. 2006. 71:449–55.
14). Lee Y., Kyung SY., Choi SJ, et al. Two cases of interstitial pneumonitis caused by rituximab therapy. Korean J Intern Med. 2006. 21:183–6.
crossref

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.

TOOLS
Similar articles