Rituximab for steroid-resistant organising pneumonia in a woman with rheumatoid arthritis

Abstract

Organising pneumonia (OP) is a form of interstitial pneumonia characterised by inflammation and scarring leading to obstruction within the small airways and alveoli. Practice guidelines recommend treatment of moderate to severe OP with glucocorticoids; however, there have been cases of steroid-resistant OP successfully treated with rituximab. We describe a case of a woman in her 20s with rheumatoid arthritis who presented with pleuritic chest pain, haemoptysis and dyspnoea on exertion and was diagnosed with OP after multiple radiographic images and biopsies. The patient failed numerous treatment regimens, including corticosteroids, antibiotics and mycophenolate, but was successfully treated with rituximab. This case highlights the importance of identifying new therapeutic agents that will minimise the use of glucocorticoids in the treatment of OP.

Cocaine-Induced Steroid Resistant Organising Pneumonia in a Young Male: The Lows of Getting High

“…There is a paucity of data on the choice of agent for steroid-resistant OP. Based on previous case reports of successful therapy with Rituximab in the steroid-resistant OP, the same was administered [9,12]. A simplified flow chart proposed for the diagnosis and management of OP is shown in Figure 4.…”