Treatment of Benign Lymphoid Hyperplasia of the Orbit With Rituximab

Abstract

Benign lymphoid hyperplasia is a disorder characterized by polyclonal lymphocytic infiltration of orbital tissues, predominantly with B-cells. Rituximab is a monoclonal antibody directed against CD20, a B-cell marker. Two patients with recurrent orbital masses involving the lacrimal glands were treated with rituximab. The diagnosis of benign lymphoid hyperplasia with predominance of CD20 cells was confirmed in both cases based on a surgical biopsy. Both patients had been previously treated with standard therapies, including high-dose steroids, and one patient had failed external-beam radiation therapy. They both responded well to treatment with intravenous rituximab. Neither patient experienced any side effects associated with rituximab.

Long-term management of orbital and systemic reactive lymphoid hyperplasia with rituximab

“…Although variable success has been reported in the management of orbital RLH;5–7 this is the first report specifically addressing orbital involvement in widespread RLH. In this study we present two patients with systemic with orbital involvement.…”

“…Rituximab is a chimeric humanized monoclonal antibody directed against CD20 receptors, found on B lymphocytes 4. Variably successful treatment of orbital RLH has been described with rituximab 5–7. In the largest series, 10 out of 11 patients (91%) with orbital RLH refractory to steroids were reported to have responded favorably 5.…”

Topical steroids eye drops in conjunctival reactive lymphoid hyperplasia

“…The lesions had no recurrence or malignant transformation after 32 months of follow-up and the only side effect experimented was poststeroid acne. [ 12 ] Ho et al [ 13 ] showed completely resolution in two months of a RLH vascularized lesion treated with subconjunctival bevacizumab injection.…”

“…None of the 10 responders has become refractory to rituximab. [ 14 ] Ho et al [ 13 ] reported successful treatment of two patients with benign lymphoid hyperplasia of the orbit with rituximab. Rituximab is a monoclonal antibody that targets the CD20 marker on B-cells inducing apoptosis in normal and pathogenic B-cells.…”

“…Adverse effects include reactivation of latent infections, infusion reactions and, rarely, multifocal leukoencephalopathy. [ 6 , 13 ] However, there is no evidence embasing use of rituximab for conjunctival RLH.…”