Rituximab-Induced Lung Injury in a Case of NHL: Diagnosis and Follow-Up on FDG PET/CT

Joshi, Prathamesh; Lele, Vikram; Saikia, Tapan

doi:10.1007/s13139-012-0156-6

Cited by 3 publications

(4 citation statements)

References 3 publications

(2 reference statements)

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“…18-FDG PET-CT is not only useful for the staging and follow up of metabolically-active lymphomas 69 but also a pathological uptake in the absence of pulmonary findings in the HRCT can raise early suspicion of drug toxicity 70,71 or leukemic infiltration and it can be useful to differentiate active lesion scarring (whether toxic, infectious or tumoral).…”

Section: Follow-up Of Pulmonary Lesionsmentioning

confidence: 99%

Hematologic neoplasms: Interpreting lung findings in chest computed tomography

Batlles

Polo

Sanz

et al. 2015

Radiología (English Edition)

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Lung disease is very common in patients with hematologic neoplasms and varies in function of the underlying disease and its treatment. Lung involvement is associated with high morbidity and mortality, so it requires early appropriate treatment. Chest computed tomography (CT) and the analysis of biologic specimens are the first line diagnostic tools in these patients, and sometimes invasive methods are necessary. Interpreting the images requires an analysis of the clinical context, which is often complex. Starting from the knowledge about the differential diagnosis of lung findings that radiologists acquire during training, this article aims to explain the key clinical and radiological aspects that make it possible to orient the diagnosis correctly and to understand the current role of CT in the treatment strategy for this group of patients. Neoplasias hematológicas; Trasplante de precursores hematopoyéticos; Neoplasias hematológicas: interpretación de los hallazgos pulmonares en la tomografía computarizada torácicaResumen La patología pulmonar en la historia de un paciente con neoplasia hematológica es muy frecuente y variable en función de la enfermedad de base y la terapia recibida. La morbimortalidad asociada es alta, por lo que requiere un tratamiento correcto y precoz. La tomografía computarizada (TC) torácica, junto con el análisis de muestras biológicas, son las ଝ Please cite this article as: Calvillo Batllés P, Carreres Polo J, Sanz Caballer J, Salavert Lletí M, Compte Torrero L. Neoplasias hematológicas: interpretación de los hallazgos pulmonares en la tomografía computarizada torácica. Radiología. 2015;57:455---470. P. Calvillo Batllés et al.Tomografía computarizada multidetector; Enfermedad pulmonar herramientas de diagnóstico de primera línea empleadas en estos pacientes, y en determinados casos se requieren métodos invasivos. La interpretación de las imágenes exige el análisis de un contexto clínico en muchas ocasiones complejo. Partiendo del conocimiento que adquiere el radiólogo en su formación sobre el diagnóstico diferencial de los hallazgos pulmonares, el objetivo de este trabajo es explicar los aspectos clínicos y radiológicos claves que permiten orientar correctamente el diagnóstico y asimilar el papel actual de la TC en la estrategia terapéutica de este grupo de enfermos.

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Section: Follow-up Of Pulmonary Lesionsmentioning

confidence: 99%

Hematologic neoplasms: Interpreting lung findings in chest computed tomography

Batlles

Polo

Sanz

et al. 2015

Radiología (English Edition)

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“…The mechanism underlying RTX-ILD is still not well understood; however, multiple mechanisms that could contribute to lung injury have been proposed, including cytotoxic T lymphocyte dysregulation due to prolonged B-cell depletion, leuco-stasis in the pulmonary circulation, the release of inflammatory cytokines, and tumor lysis syndrome [ 3 , 5 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, some patients on RTX have had radiological abnormalities in the lungs without having any overt symptoms [3]. Fluorodeoxyglucose positron emission tomography-CT is a very sensitive modality for identifying RTX-ILD, and this approach can detect early disease [3][4][5].…”

Section: Discussionmentioning

confidence: 99%

A Rare Presentation of Concomitant Lung Disease and Hepatitis After Rituximab Treatment: A Case Report

Albusoul¹,

Abunafeesa²,

Dabak³

2023

Cureus

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Rituximab (RTX) is a chimeric monoclonal antibody that is a standard component of treatment for all B-cell malignancies. The most common adverse events related to RTX are infusion-related reactions, such as fever, chills, urticaria, flushing, and headaches. However, RTX-induced lung disease (RTX-ILD) is a rare but potentially fatal adverse reaction, and diagnosing RTX-ILD is challenging, especially when accompanied by other rare adverse reactions, such as hepatitis. Here, we report a case of RTX-ILD with concomitant RTX-induced hepatitis in a 55-year-old man with follicular B-cell non-Hodgkin lymphoma who was on maintenance RTX therapy. The patient presented with a subacute, persistent dry cough, shortness of breath, fevers, and chills shortly after having traveled. Outpatient antibiotic therapy did not relieve symptoms, and laboratory studies revealed evidence of liver injury. A computed tomography (CT) of the chest showed predominately basilar airspace disease and ground glass opacities suggestive of multifocal pneumonia. Extensive infectious and autoimmune workups were negative. RTX-ILD with concomitant RTX-induced hepatitis was considered because antibiotic therapy did not resolve symptoms or improve signs of liver damage. Prednisone (1 mg/kg) led to symptom resolution and liver enzyme improvement. The patient underwent a 30-day steroid taper and the withholding of RTX infusions. A CT of the chest three months after discharge showed nearly resolved multifocal ground glass opacities. RTX-ILD should be considered after infectious and autoimmune etiologies have been ruled out for all patients on RTX therapy who experience symptoms of lung pathology or infection.

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“…La 18-FDG PET-TC no solo es útil en la estratificación y el seguimiento del linfoma metabólicamente activo 69 , sino que una captación patológica en ausencia de hallazgos pulmonares en la TCAR puede hacer sospechar de forma precoz toxicidad por drogas 70,71 o infiltración leucémica, y puede ser útil para diferenciar cicatrices de lesiones activas (toxicas, infecciosas o tumorales).…”

Section: Seguimiento De Las Lesiones Pulmonaresunclassified