Authors: Shoko Goto Hiroaki Goto Reo Tanoshima Hiromi Kato Hiroyuki Takahashi Osamu Sekiguchi Sumio Kai
Publish Date: 2009/03/24
Volume: 89, Issue: 3, Pages: 305-309
Abstract
Rituximab a chimeric murine/human monoclonal antiCD20 antibody was licensed for the treatment of Bcell lymphoma and has also shown efficacy against autoimmune diseases such as immune thrombocytopenic purpura ITP It is relatively safe however about 1–20 of patients were reported to have developed rituximabinduced serum sickness which is more common among patients with autoimmune conditions than among those with hematologic malignancies Here we describe a pediatric patient with steroiddependent chronic ITP who presented with arthralgia and fever ten days after the second infusion of rituximab on day 10 and presented with malaise and maculopapular rash on day 21 Oral prednisolone was started and his symptoms resolved He had an elevated level of human antichimeric antibody HACA on day 27 thereafter the HACA level slowly decreased To our knowledge among pediatric patients who received rituximab for chronic ITP this is the sixth documented case of serum sickness and the only one who manifested an elevated level of HACA Rituximab is a beneficial treatment option against chronic ITP however the risk of serum sickness should be considered Steroid usually used for the treatment of serum sickness may prevent the development of severe serum sickness when administered during and after rituximab treatment
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