Reactions 1453 - 25 May 2013

SRituximab

Fatal interstitial lung disease in an elderly patient:case report

A 71-year-old woman developed fatal interstitial lungdisease after receiving rituximab for lymphoma treatment.

The woman presented to an emergency department withnew onset dry cough, dyspnoea and fever of 40°C. She hadbeen diagnosed 3 months earlier with diffuse large B-celllymphoma, and had received three consecutive cycles of R-CHOP chemotherapy conducted once every 4 weeks,including rituximab 375 mg/m2 on day 1 [route not stated]. Thelast course of chemotherapy had been completed 3 weeksbefore her presentation. Two days previously, a chest X-ray ata local health centre had shown a few infiltrates in the middleand lower lung fields.

The woman was started on antibiotics for suspectedpneumonia, and noninvasive bilevel positive airway pressureventilation was commenced. Her hypoxia did not improvewith antibiotic and antifungal therapy. A bedside chest filmrevealed bilateral generalised ground glass opacity, and aworking diagnosis of rituximab-induced interstitial lungdisease was reached. She was given methylprednisolone,azithromycin, amphotericin-B liposomal, cotrimoxazole,foscarnet and caspofungin. After 4 days, there was noimprovement, and she was started on etanercept. Herrespiratory condition improved slightly, but soon declined,with pulmonary X-ray findings worsening. Tracheal intubationand invasive artificial ventilation were started, but she died18 days after admission.

Author comment: "[The patient] developed a fatalrespiratory failure, which was eventually diagnosed asrituximab-induced interstitial lung disease (R-ILD)".Wu Y, et al. Fatal interstitial lung disease induced by rituximab-containingchemotherapy, treatment with TNF-alpha antagonist and cytokine profiling: Acase-report and review of the literature. Journal of Clinical Pharmacy andTherapeutics 38: 249-253, No. 3, 2013. Available from: URL: http://dx.doi.org/10.1111/jcpt.12052 - China 803087073

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Reactions 25 May 2013 No. 14530114-9954/10/1453-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved