A case of late-onset neutropenia secondary to rituximab in a patient with mucous membrane pemphigoid

Low prevalence of late-onset neutropenia after rituximab treatment in patients with pemphigus

“…Rituximab (anti-CD20 antibody) is a first-line treatment option, 2 but its use across a range of nondermatologic conditions has been associated with development of late-onset neutropenia (LON), occurring 4 to 48 weeks after treatment, with a prevalence between 1.3% and 29.9%. 3,4 Despite cases of rituximab-associated LON reported in other autoimmune blistering diseases, 5 a systemic evaluation of rituximab-associated LON in pemphigus is lacking.…”

Rituximab‐mediated late onset neutropenia in autoimmune blistering diseases: negligible or under‐estimated threat?

“…The frequently asymptomatic course accounts for a substantial risk of under-detection. Severe infectious complications [7,8,10,11,13] including fatalities [12], however, may occur. Administration of filgrastim was demonstrated to shorten the time to recovery, but did not affect overall outcomes [11].…”

“…National [1] and international [6] pemphigus treatment guidelines refer to infections as a significant adverse effect of rituximab, but fail to mention late-onset neutropenia (LON) as a possibly under-estimated trigger of infectious complications. Late-onset neutropenia was observed following administration of rituximab regardless of the underlying disease [7][8][9][10][11][12][13] and has clearly been documented in pemphigus patients [14]. Dermatologists, however, are commonly unaware of this potentially serious condition.…”