Elsevier

Joint Bone Spine

Volume 75, Issue 3, May 2008, Pages 362-365
Joint Bone Spine

Case report
Organizing pneumonia after rituximab therapy: Two cases

https://doi.org/10.1016/j.jbspin.2007.10.009Get rights and content

Abstract

Rituximab, a chimeric monoclonal antibody against CD20, very rarely causes lung toxicity. Clinical presentations include lung infiltrates, alveolar hemorrhage, and adult respiratory distress syndrome. Three cases of organizing pneumoinia (formerly called bronchiolitis obliterans with organizing pneumonia or BOOP) have been reported. In our experience, organizing pneumonia occurred in 2 of 25 patients treated with rituximab, for RA and Castleman's disease, respectively. Because organizing pneumonia may be asymptomatic, as illustrated by one of our cases, we recommend obtaining a chest radiograph routinely before rituximab re-treatment.

Section snippets

Case report 1

This 64-year-old woman who had seropositive RA with joint erosions diagnosed 4 years earlier, in 2002, was taking 5–10 mg of prednisone per day in combination with methotrexate, then leflunomide, and finally methotrexate plus anakinra. TNFα antagonists were not used, as she had a history of lower-limb paralysis at 25 years of age consistent with a possible demyelinating disease. In October 2006, her disease remained active, as shown by the following variables: visual-analog-scale pain score,

Case report 2

A 55-year-old woman with RA since 1970 had joint destruction despite limited disease activity. She had a history of valve replacement surgery in 2003 to treat aortic incompetence. In 2001, she was evaluated for urticarial vasculitis, high blood eosinophil counts, and marked bilateral lymph-node enlargement at multiple sites (groin, axilla, retroperitoneal space, and pelvis). Lymph-node biopsy findings consisted of atypical lymphoid hyperplasia, immunoblasts, and numerous polyclonal plasma

Discussion

The clinical, lung function test, and imaging findings in organizing pneumonia lack specificity, so that the definitive diagnosis is dependent on obtaining a histological specimen [8]. The diagnosis was confirmed histologically in both of our patients. A gradually worsening dry cough with dyspnea, a fever, and asthenia are the most common clinical manifestations [8], [9]. Chest pain may be a feature, as in our patient #1. The disease may be discovered fortuitously when a chest radiograph is

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