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Kim, Moon, Heo, Lee, Lee, Jeong, and Park: A Case of Rituximab Use in Rheumatoid Arthritis Following Anti-TNF-Associated Tuberculosis
Case Report
Journal of Rheumatic Diseases

Journal of Rheumatic Diseases 2012; 19(2): 100-103.

Published online: 30 April 2012

DOI: https://doi.org/10.4078/jrd.2012.19.2.100

A Case of Rituximab Use in Rheumatoid Arthritis Following Anti-TNF-Associated Tuberculosis

Kyeong-Hyun Kim, Ki Won Moon, Jeong Won Heo, Won-Ho Lee, Sang-Hoon Lee, Cheol-Min Jeong, Hyun-Sun Park

Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea.

Corresponding to: Ki Won Moon, Department of Internal Medicine, Kangwon National University School of Medicine, 17-1, Hyoja3-dong, Chuncheon 200-947, Korea. kiwonmoon@kangwon.ac.kr

Received 8 August 2011       Revised 5 September 2011       Accepted 6 September 2011

Copyright © 2012 by The Korean College of Rheumatology

(free-access):

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Rituximab has been shown to be effective in rheumatoid arthritis (RA) and is recommended for patients exhibiting an inadequate response to tumor necrosis factor (TNF) inhibitors. To date, there have been no reports of tuberculosis in RA patients treated with rituximab. We report the use of rituximab in a TNF inhibitor-refractory RA patient who had developed tuberculosis. A 52-year-old man with RA had been treated with adalimumab for 3 months, but failed to respond well to the treatment. He reported fever, coughing, sputum, and weight loss. He was diagnosed with pulmonary tuberculosis and started anti-tuberculosis medication. His arthritis was not controlled for despite increasing the dose of prednisolone. He was treated with rituximab without serious adverse effects. Sixteen weeks later, he demonstrated improvement with both arthritis and tuberculosis.

Keywords: Rheumatoid arthritis, TNF inhibitor, Rituximab, Tuberculosis

Figures and Tables

Figure 1
Simple chest radiograph showed nodules and linear opacities in the right upper lobe prior to 3 months regarding admission (A). Progression of nodular infiltrates in the right upper lobe suggests the progression of active tuberculosis at admission (B).
jrd-19-100-g001
Figure 2
High resolution computed tomography scan of the chest indicated multiple centrilobular nodules and nodular consolidation in the right upper lobe.
jrd-19-100-g002

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