A Case of Interstitial Lung Disease Probably Related to Rituximab Treatment

• Published in: Drug safety - case reports Vol. 2; no. 1
• Main Authors: Calderazzo, Massimo, Rende, Pierandrea, Gambardella, Paolo, De Sarro, Giovambattista, Gallelli, Luca
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-12-2015
• Subjects: Case Report; Drug Safety and Pharmacovigilance; Medicine; Medicine & Public Health; Pharmacology/Toxicology; Interstitial Lung Disease; Fluticasone; Naranjo Probability Scale; Everolimus; Salmeterol
• ISSN: 2199-1162; 2198-977X
• DOI: 10.1007/s40800-015-0010-8

A 44-year-old male developed interstitial lung disease (ILD) during treatment with rituximab (375 mg/m
2
weekly intravenous × 4 weeks) for the management of immune thrombocytopenia (ITP). After 1 month of treatment he developed dyspnea, fever (38.9 °C), an increase of C-reactive protein (CRP) and white blood cells with hypoxemia, and decreased platelets. Chest X-ray and high-resolution computed tomography revealed diffuse bilateral lung infiltrates. He was diagnosed with severe ILD; rituximab was discontinued, and treatment with fluticasone combined with salmeterol, methylprednisolone, and omeprazole was started, with an improvement of symptoms over 15 days with normalization in CRP at 30 days. A Naranjo assessment score of 6 was obtained, indicating a probable relationship between the patient’s symptoms and the suspect drug. In conclusion, in ITP patients treated with rituximab, we suggest evaluating pulmonary endpoints through pharmaco-epidemiological observational studies.