Rituximab-induced serum sickness in a patient with refractory chronic immune thrombocytopenic purpura: a case report and review of the literature

摘要

Although common side effects such as fever, chills and rigors are commonly seen during the first infusion of rituximab; delayed ones such as serum sickness and Steven-Johnson syndrome have rarely been reported. We report an adult patient with steroid resistant and splenectomized chronic immune thrombocytopenic purpura who presented with fever, arthralgia, asthma like respiratory symptoms, maculopapular rash, and palpable purpuric lesions 2 days after the third infusion of rituximab. Withdrawal of rituximab and subsequent treatment with i.v. steroid and antihistaminics improved the patient’s clinical and physical findings. In such cases rituximab should be discontinued, complete and rapid resolution can be possible with systemic steroid treatment. Keywords: Rituximab, chronic immune thrombocytopenic purpura, CD20, serum sickness, intravenous immunoglobulin ?zet Ate?, titreme ve kas?lma gibi yan etkiler ilk kez yap?lan rituksimab infüzyonu s?ras?nda s?k?a g?rülmesine kar??l?k, serum hastal??? ve Steven-Johnson sendromu gibi gecikmi? yan etkiler nadir olarak bildirilmi?tir. Steroide diren?li ve splenektomize kronik immün trombositopenili bir hasta, ü?üncü rituksimab infüzyonundan iki gün sonra ate?, artralji, ast?m benzeri solunum sistemi semptomlar?, makülopapüler ra? ve palpabl purpurik lezyonlar ile ba?vurdu. Rituksimab?n kesilmesi, sonras?nda intraven?z steroid ve antihistaminik tedavi uygulanmas? ile hastan?n klini?i ve fiziki bulgular? düzeldi. Bu gibi vakalarda rituksimab?n kesilmesi ve sistemik steroid tedavi uygulanmas? ile tam ve h?zl? bir düzelme sa?lanabilece?ini dü?ünmekteyiz. Anahtar s?zcükler : Rituksimab, kronik immün trombositopenik purpura, CD20, serum hastal???, intraven?z immunoglobulin