Rituximab Induced Interstitial Lung Disease in Patients with Non-Hodgkin’s Lymphoma: A Clinical Study of Six Cases and Review of the Literature

Abstract

Background.Rituximab-induced lung disease (R-ILD) is a rare entity that should be considered in patients treated with rituximab who present with dyspnea, fever, and cough but no clear evidence of infection.Aim.The aim of this prospective longitudinal study is to describe the clinical presentation, management, and response to rechallenge in patients diagnosed with rituximab induced ILD over a period of one year.Results.Out of sixteen patients with CD20 positive non-Hodgkin’s lymphoma who received rituximab along with standard chemotherapy, six patients developed features suggestive of R-ILD. Four (66.6%) of these patients had diffuse large B cell lymphoma. The median time of presentation of R-ILD was after the 3rd cycle of chemotherapy. Three patients (50%) presented with acute onset of high fever, dyspnea, and dry cough while the remaining three presented with insidious onset of dyspnea and dry cough. An infectious etiology for the respiratory illness was ruled out in all patients with an exhaustive work-up. Four patients (66.6%) responded to corticosteroid treatment and supplemental oxygen. One patient required mechanical ventilation and succumbed to ILD while another required prolonged supplemental oxygen. Two (33.3%) of patients were successfully rechallenged with rituximab under cover of corticosteroids.Conclusions.Rituximab induced lung disease is a rare but potentially fatal pulmonary toxicity which requires a high index of suspicion for early diagnosis and treatment.

Rituximab-Induced Interstitial Lung Disease: A Stitch in Time Saved Nine

“…The onset of pulmonary complications after the third or fourth dose of rituximab as happened in our case is not unusual and has been described by Liote et al In the largest case series of 45 patients [ 2 ]. Krishnaswamy et al also reported six patients of rituximab-induced ILD in patients of non-Hodgkin lymphoma whereby the median time of presentation was usually after the third dose and the presenting symptoms were acute onset of fever, cough, and SOB or its combinations [ 5 ].…”

“…Treatment of rituximab-induced ILD is supplement oxygen, methylprednisolone, and supportive ventilation [ 5 , 6 ]. The dosage and duration of steroids are not yet standardized as the cases encountered are quite rare.…”

Rituximab-induced interstitial lung disease in a patient with follicular lymphoma: A rare case report

“…Rare respiratory side effects, mostly described in recent literature include transient respiratory symptoms as part of an infusion-related reaction, hypersensitivity pneumonitis, interstitial pneumonitis, organizing pneumonia, pulmonary fibrosis, and alveolar hemorrhage. [ 5 ]…”

Rituximab Induced Interstitial Lung Disease Diagnosis, Treatment Outcome, and Risk’s Factor, a Place for Transbronchial Pulmonary Cryobiopsy

“…Lung examination revealed diffuse bilateral scattered inspiratory crackles, tachycardia, tachypnea, and hypoxemia requiring 3 L of oxygen. Laboratory test showed a white blood cell count of 5900/mm 3 A positron emission tomography (PET-SCAN) is requested as part of unexplained hypercalcemia to exclude a malignant tumor and bone metastases and sarcoidosis but did not reveal any malign lesion and ruled out any extra-pulmonary pathological suspicious abnormalities (Figure 4).…”

“…Details of RTX-ILD have been described in a systematic review [3], and the most common symptoms are dry cough, exertional dyspnea, and fever. Nonspecific symptoms are less common and included fatigue, rigors, wheeze, hemoptysis, skin rash, and pleuritic chest pain.…”