A Case of Primary Biliary Cirrhosis That Progressed Rapidly after Treatment Involving Rituximab

Abstract

Primary biliary cirrhosis (PBC) is a progressive liver disease for which limited therapies are recommended. Rituximab, an anti-CD20 monoclonal antibody, is expected to be a useful therapeutic regimen for PBC. Previous studies indicated biochemical and immunological improvement in PBC after rituximab treatment. Although rituximab shows therapeutic potential for PBC, few cases have been reported and histological improvement and long-term outcome remain uncertain. Here, we report a case of PBC in a 66-year-old Japanese female patient who presented with a gastric lymphoma and who had been treated with a regimen containing rituximab for incidental malignant lymphoma. She showed biochemical and immunological improvements, and liver histology before and after rituximab treatment confirmed a decrease in liver inflammation. However, she developed liver cirrhosis a short time after rituximab treatment without biochemical or immunological worsening. Rituximab treatment for PBC might be considered and careful observation is required after treatment.

Primary Biliary Cholangitis: Its Pathological Characteristics and Immunopathological Mechanisms

“…This is regarded as an important issue of infection control in the performance of B-cell removal therapy. We also encountered a case of PBC that rapidly progressed to liver cirrhosis after a treatment including rituximab (55). A 66-year-old Japanese female patient with PBC who presented with gastric lymphoma had been treated with a regimen containing rituximab for incidental malignant lymphoma.…”

DLBCL developed into fatal liver failure during rituximab-containing chemotherapy

“…In most cases, rituximab was used in combination with other drugs that may induce liver injury, as in this case, and we were unable to conclude whether liver injury was solely due to rituximab therapy 3 - 6 . In two cases, rituximab was administered to patients with concomitant liver damage, which suggests that rituximab can exacerbate liver dysfunction 6 , 7 . In one case, rituximab led to death in a short period after hematopoietic stem cell transplantation 7 .…”

Rapid activation and hepatic recruitment of innate-like regulatory B cells after invariant NKT cell stimulation in mice

“…In patients with liver disease, Rituxan ® treatment has been associated with reactivation of hepatitis B, improvement of autoimmune hepatitis, limited change in most patients with primary biliary cirrhosis (PBC), but an acute exacerbation of disease in a patient with PBC [49][50][51][52]. In addition, B cell depletion was associated with a marked exacerbation in liver injury in a mouse model of PBC [44].…”