Interstitial Pneumonitis and Alveolar Hemorrhage Complicating Use of Rituximab

Abstract

The use of rituximab has been uncommonly associated with delayed pulmonary toxicity. We present a case of interstitial pneumonitis and diffuse alveolar hemorrhage, which represents the second such case reported in the literature.

Rituximab-induced lung disease: a systematic literature review

“…In six patients, the onset was hyperacute [17][18][19], and, in three patients, it was chronic [16,33,40]. The distributions of tempo of onset and time to onset from the last rituximab infusion showed a nearly perfect match (table 2) and were significantly linked (p,1610 -16 ): the five early-onset cases were hyperacute; 36 out of the 37 delayedonset cases were acute or subacute; and the three late-onset cases were chronic.…”

“…The interval between cycles was 8, 15 or 21 days. Rituximab alone was used in seven patients [20,21,24,26,33,37,40], and with stable-dosage methotrexate for maintenance therapy of RA in one [16]. The other 37 patients received rituximab in combination with multiple chemotherapy regimens (COP, CHOP, CEOP, CVP, ACVBP, VNCOP, fludarabine, cladribine and growth factors (where C is cyclophosphamide, O vinblastine, P prednisone, H doxorubicin, E epirubicin, V etoposide, A Adriamycin, B bleomycin and N mitoxantrone)).…”

“…Thus 37 patients experienced delayed-onset forms [3,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. Finally, the third peak reflected late-onset forms, occurring 1-3 months after the last infusion in three patients [16,33,40].…”

“…None of these patients were receiving anticancer chemotherapy. The diagnoses were RA [16], gastric MALT lymphoma [33] and Waldenströ m's macroglobulinaemia [40]. Clinically silent pulmonary macronodules and BALF lymphocytosis were the only manifestations.…”

Lung lesion caused by the use of disease-modifying antirheumatic drugs in patients with rheumatoid arthritis

“…Применение ритуксимаба может быть связано с за-медленной легочной неблагоприятной реакцией -интер-стициальным пневмонитом и диффузным альвеолярным кровотечением [54]. Такие неблагоприятные реакции со стороны легких, как кашель, бронхоспазм, одышка, рас-пространены (до 38%), другие состояния -криптогенная пневмония, интерстициальный пневмонит и диффузное альвеолярное кровотечение -встречаются редко [55].…”