摘要:
Objective: To discuss the pathogenesis,clinical manifestations,diagnosis,differential diagnosis, treatment,and prognosis of the patient with rituximab (RTX)-induced interstitial lung disease (ILD) (RTX-ILD).Methods:A male patient aged 19 years old was confirmed as classical Hodgkin's lymphoma more than 2 years ago,and received autologous hemopoietic stem cell transplantation (HSCT)when the disease recurred 1 year ago.Two months after HSCT,the maintenance chemotherapy was given every month with 375 mg· m-2 RTX,but the mediastinal recurrence appeared during the period,then the mediastinal residual lesion radiotherapy was done for 10 times.However,8 d after the third RTX chemotherapy,the patient experienced post-exercising tachypnea,fever,cough,chest congestion,and limb weakness.The chest CT scanning results suggested ground gloss opacity on both lungs,and blood gas analysis suggested a hypoxemia.Neither antibacterial nor antifungal treatment worked well.Afterwards,the sequential etiological examination showed the negative results,and the bronchoscope examination showed the normal results as well.Considering about the possibility of RTX-ILD,RTX was stopped immediately and turned to intravenous infusion of methylprednisolone 40 mg per day.Results:Five d later,the symptoms of the patients were improved,and the follow-up methylprednisolone was changed to oral and gradually reduced to discontinuation.Conclusion:RTX-ILD is relatively rare,and its clinical manifestations lack specificity. Hormonotherapy is the main method in treatment of RTX-ILD. The patients sensitive to hormonotherapy have better prognosis than those insensitive to hormonotherapy.%目的:探讨利妥昔单抗(RTX)致间质性肺疾病(ILD)(RTX-ILD)的发病机制、临床表现、诊断、鉴别诊断、治疗和预后.方法:1例19岁男性患者,确诊经典型霍奇金淋巴瘤2+年,1年前疾病复发,复发后行自体造血干细胞移植(HSCT),移植后2个月开始每月以375 mg·m-2 RTX维持化疗,期间纵隔复发行纵隔残留病灶放疗10次,第3次RTX维持治疗后第8天,患者出现活动后呼吸困难,伴发热、咳嗽、胸闷和乏力.胸部CT提示双肺多发斑片状磨玻璃影,血气分析提示低氧血症.先后给予抗细菌及抗真菌治疗,效果均不理想.后续反复多次行病原学检查均为阴性,支气管镜检查仍未见明显异常,考虑到RTX-ILD的可能,立即停用RTX并静脉给予40 mg·d-1甲强龙治疗.结果:5 d后患者症状好转,后续激素改为口服并逐渐减量至停用.结论:RTX-ILD相对罕见,临床表现缺乏特异性,治疗以激素为主,对激素敏感者预后较好,激素不敏感者预后较差.