Focal Rituximab-Induced Edematous Reaction at Primary Cutaneous Follicle Center Lymphoma Lesions: Case Report and Literature Review

Abstract

Primary cutaneous follicle center lymphoma (PCFCL) is the most common cutaneous B cell lymphoma. It is most often indolent and responds well to rituximab. We present a case of transient rituximab-induced edematous lesions located exclusively on tumor papules in a patient treated for PCFCL. Based on this observation and on a review of the literature, we discuss the mechanism of this edematous reaction which does not seem to be allergic. Indeed, this focal reaction observed solely during the first infusion of rituximab is more likely linked with local cytokine release induced by B cell lysis in the skin. This reaction is neither unusual nor severe and should not lead to an interruption of rituximab.

Diagnosis and Management of Cutaneous B-cell Lymphoma

“…Clinicians should be aware that case reports of localized edema or urticaria have been described in the CBCL skin lesions in these patients after systemic treatment with rituximab. 24,25 Patients with the development of extracutaneous disease should be treated as patients with nodal follicular lymphoma.…”

Dermatolojide Rituksimab Kullanımı

“…Buda-Okreglak ve ark ise yeni, gecikmiş proinflamatuvar sendrom olarak, romatoid artriti taklit eden el ve dizi etkileyen rituksimab yan etkisi tanımlamıştır (7.) Brunet ve ark rituksimabla ilişkili ödematöz lokal bir reaksiyon gelişimi bildirmişler, ancak bu durumun tedaviyi kesmeyi gerektirmediğini düşünmüşlerdir (8). Kim ve ark ise rituksimab tedavisiyle ilişkili olarak bir olguda kutanöz vaskülit gelişimi bildirmişlerdir (9).…”

“…B hücre azalması anti-platelet, anti-eritrosit, ve anti-fosfolipid antikorları SLE hastalarında azaltabilmektedir. Rituksimab dirençli otoimmun trombositopenisi olan SLE hastası bir kız çocuğunda etkili bulunmuştur (4,8 (4,128,129).…”

Rituximab‐related urticarial reaction overlying primary cutaneous follicle centre lymphoma: histological appearance and pathophysiological hypotheses

“…Rituximab is used to treat low-grade cutaneous B-cell lymphomas with multiple lesions. 1 Immediate urticarial reactions to rituximab developing over tumour lesions have been described in case reports [2][3][4] but their histological appearance and pathophysiology remain poorly described. We report a case focusing on histology, which may contribute to elaborating pathophysiological hypotheses.…”

“…However, in low-grade cutaneous B-cell lymphomas treated with IV rituximab, acute urticarial reactions limited to tumour site were previously reported during the first infusions. [2][3][4] The histological appearance of these reactions remains poorly described and their pathophysiological significance unclear. The nuclear debris and infiltration of cytotoxic effectors and neutrophils, without vasculitis or urticarial changes, seen in our patient's urticarial reaction (but not in the pretreated lesion) seem to reflect the early CMC and ADCC antitumour effects of rituximab, rather than an immediate hypersensitivity phenomenom.…”