Rituximab-induced late-onset neutropenia

Sahu, Kamal Kant; Petrou, Nathan; Cohn, Zachary; Khanna, Shrinkhala

doi:10.1136/bcr-2019-233569

Cited by 7 publications

(2 citation statements)

References 8 publications

(7 reference statements)

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“…Time before onset has been reported to range from 38 to 175 days 9 , with an average duration of 5 to 77 days 10 . The exact incidence of R-LON is unknown, and so is its pathophysiology 11 , but its prevalence is estimated at 1.3 to 27%, depending on the underlying disease. In most cases, it has a benign course with a spontaneous resolution 9 .…”

Section: Discussionmentioning

confidence: 99%

Myelotoxicity and kidney dysfunction related to the use of trimethoprim-sulfamethoxazole for the treatment of Pneumocystis jirovecii pneumonia: a case report of severe adverse events with a common drug

Mendes,

Mamani,

Coelho

et al. 2024

Rev. Inst. Med. trop. S. Paulo

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Trimethoprim-sulfamethoxazole (TMP-SMX) is the primary therapeutic option for Pneumocystis jirovecii pneumonia (PCP). Gastrointestinal symptoms and cutaneous rash are common side effects, with hyperkalemia being uncommon in patients without kidney dysfunction, and myelotoxicity being even rarer. We present the case of a male patient with hypertension and a recent diagnosis of non-Hodgkin lymphoma, undergoing rituximab treatment for two months. He was admitted to the intensive care unit due to dyspnea, tachypnea, and pleuritic pain, requiring mechanical ventilation. Chest computed tomography showed bilateral and multilobed ground-glass opacities, compromising more than 80% of the lung parenchyma. Pulmonary tuberculosis and COVID-19 were ruled out. An angiotomography and Doppler ultrasound revealed an extensive pulmonary thrombus and deep venous thrombosis. Empiric treatment with TMP-SMX for PCP was initiated, but within four days, the patient experienced metabolic acidosis and severe hyperkalemia, necessitating hemodialysis. He also presented with progressive pancytopenia and critical levels of leukopenia and thrombocytopenia. The hypothesis of TMP-SMX-induced myelotoxicity was suspected. Considering the unavailability of an alternative treatment, it was opted to continue TMP-SMX and initiate a granulocyte-colony-stimulating factor. However, the patient maintained medullary deterioration, becoming refractory to the transfusion of blood derivates. On the 17 th day of treatment, a clinical decision was made to suspend TMP-SMX, leading to improvements within 48 hours in marrow and kidney functions, metabolic acidosis, and hyperkalemia. Despite all efforts, the patient died after 35 days of hospitalization due to hospital-acquired infections. This case highlights the importance of clinicians recognizing potential myelotoxicity with TMP-SMX and promptly discontinuing the drug if necessary.

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Section: Discussionmentioning

confidence: 99%

Myelotoxicity and kidney dysfunction related to the use of trimethoprim-sulfamethoxazole for the treatment of Pneumocystis jirovecii pneumonia: a case report of severe adverse events with a common drug

Mendes,

Mamani,

Coelho

et al. 2024

Rev. Inst. Med. trop. S. Paulo

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“…Of note, an increased risk of severe infections in rituximab treated patients has been found in those with CKD, diabetes, or hypogammaglobulinemia (84)(85)(86)(87). Moreover, several studies reported late-onset neutropenia, occurring usually several months following the administration of rituximab (88)(89)(90).…”

Section: Rituximab -Uncontrolled Experiencementioning

confidence: 99%

Therapies for Membranous Nephropathy: A Tale From the Old and New Millennia

et al. 2022

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Primary Membranous Nephropathy (PMN) is the most frequent cause of nephrotic syndrome in adults. If untreated, PMN can lead to end-stage renal disease; moreover, affected patients are at increased risk of complications typical of nephrotic syndrome such as fluid overload, deep vein thrombosis and infection. The association of PMN with HLA-DQA1 and the identification in around 70% of cases of circulating autoantibodies, mainly directed towards the phospholipase A2 receptor, supports the autoimmune nature of the disease. In patients not achieving spontaneous remission or in the ones with deteriorating kidney function and severe nephrotic syndrome, immunosuppression is required to increase the chances of achieving remission. The aim of this review is to discuss the evidence base for the different immunosuppressive regimens used for PMN in studies published so far; the manuscript also includes a section where the authors propose, based upon current evidence, their recommendations regarding immunosuppression in the disease, while highlighting the still significant knowledge gaps and uncertainties.

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Rituximab

2020

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Rituximab-induced late-onset neutropenia

Cited by 7 publications

References 8 publications

Myelotoxicity and kidney dysfunction related to the use of trimethoprim-sulfamethoxazole for the treatment of Pneumocystis jirovecii pneumonia: a case report of severe adverse events with a common drug

Myelotoxicity and kidney dysfunction related to the use of trimethoprim-sulfamethoxazole for the treatment of Pneumocystis jirovecii pneumonia: a case report of severe adverse events with a common drug

Therapies for Membranous Nephropathy: A Tale From the Old and New Millennia

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