Rituximab

Abstract

Serum sickness: case reportA 39-year-old man developed serum sickness during treatment with rituximab for antiphospholipid syndrome (APS). The man, who presented to the hospital with flank and abdominal pain, had extensive thrombosis of the inferior vena cava. Antibeta-2-microglobulin and anticardiolipin antibodies confirmed the diagnosis of APS. He had undergone thrombectomy with partial recanalisation of inferior vena cava during hospitalisation. He was discharged on unspecified anticoagulants. Afterwards, he returned to the hospital with complaints of chest pain. Imaging studies confirmed the diagnosis of Budd-Chiari syndrome (BCS), which was further complicated by type 2 myocardial infarction, acute renal failure and ischaemic liver injury in the setting of catastrophic antiphospholipid syndrome (CAPS). He received plasmapheresis, azathioprine, immuneglobulin [IVIG], unspecified steroids and hydroxychloroquine with improvement in liver enzymes. He started receiving rituximab infusions [route and dosage not stated] to manage the increased antiphospholipid antibody titers during hospitalisation. Immediately, he developed rash, fevers and lymphadenopathy, which was consistent with rituximab-induced serum sickness [duration of treatment to reaction onset not stated].Rituximab was discontinued, and the therapy was switched to ocrelizumab and mycophenolic acid for management of the APS [ADR outcome not stated].