Rituximab induced cytokine release syndrome in an MS patient: A case report

Etemadifar, Masoud; Salari, Mehri; Saeri, Mahdieh; Sigari, Amirhossein Akhavan; Pelarti, Sara Ebrahimi

doi:10.1002/ccr3.4407

Cited by 3 publications

(1 citation statement)

References 19 publications

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“…This method involves gradually administering increasing doses of the drug [7,8]. Rapid IgE desensitization inhibits IL-6 [8], and studies [9] showed a 75% reduction in IL-6 production post-desensitization.…”

Section: Introductionmentioning

confidence: 99%

Stability Analysis in a Mathematical Model for Allergic Reactions

Abdullah,

Badralexi,

Halanay

2024

Axioms

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We present a mathematical model that captures the dynamics of the immune system during allergic reactions. Using delay differential equations, we depict the evolution of T cells, APCs, and IL6, considering cell migration between various body compartments. The biological discussions and interpretations within the article revolve around drug desensitization, highlighting one potential application of the model. We conduct stability analysis on certain equilibrium points, demonstrating stability in some cases and only partial stability in others. Numerical simulations validate the theoretical findings.

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Section: Introductionmentioning

confidence: 99%

Stability Analysis in a Mathematical Model for Allergic Reactions

Abdullah,

Badralexi,

Halanay

2024

Axioms

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Rituximab

2021

Reactions Weekly

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Cytokine release syndrome: case reportA 44-year-old man developed cytokine release syndrome during treatment with rituximab for relapsing-remitting multiple sclerosis.The man, who had a history of relapsing-remitting multiple sclerosis, was referred to a clinic in Iran for the evaluation of bilateral oedema of the lower limbs. The oedema appeared shortly after he had received his last rituximab infusion. He also complained of headache and generalised arthralgia. Upon physical examination, bilateral symmetric pitting oedema of the lower limbs was found evident, no skin lesions were present, vital signs were stable and he was not febrile. Lab data showed an increased level of serum creatinine, SGPT, SGOT and C-reactive protein. He had normal haemoglobin, haematocrit, white blood cell count, and mildly decreased platelet counts. On 2001, he had experienced a right side optic neuritis and one year later he had ataxia and diplopia. A MRI of the brain and spinal cord were done, which revealed hyperintense lesions at the level of the cervical spinal cord. He was diagnosed with multiple sclerosis (MS) and interferon-beta 1a was initiated. Five years later, he had an attack of bilateral lower limb paresis, and 3 years later, he experienced a severe attack of quadriparesis. After the acute management of his attack, his drug was changed to fingolimod. On 2018, when he was on fingolimod for 2 years his drug was again changed to rituximab by another neurologist. After the first dose of IV infusion of rituximab [Zytux] 1 gram, he experienced a severe infusion reaction, presented by erythema and urticarial lesions. Two days later, he noticed to have bilateral oedema of the lower limbs, that had gradually worsened and somnolence was observed. He was evaluated by several specialists regarding his limb oedema.The man's symptoms improved with unspecified antihistamines and corticosteroids. After 6 months, when the man again received his second dose of IV infusion of rituximab 1 gram, he presented again with bilateral limb oedema. Consult with an infectious disease specialist was done to rule out any infectious causes or sepsis. Based on his history and by taking into account lab data, cytokine release syndrome was diagnosed secondary to rituximab [exact duration of treatment to reaction onset not stated]. He was managed with unspecified antihistamines and corticosteroids. Prednisolone was started and titrated over the course of 4 weeks. His symptoms were improved in 2 weeks, and limb oedema was completely resolved on week four of follow-up.

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Pathomechanism of Adverse Reactions to Biological Treatment of Inflammatory Skin Conditions

Li,

Naisbitt,

Sun

et al. 2024

Clin Experimental Allergy

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Biological agents are widely used across medicine, including for immune‐mediated skin conditions such as psoriasis and atopic dermatitis. When used to treat a relevant pathological process, they demonstrate impressive efficacy and credible safety, helping to achieve remission and improved function and quality of life. However, with their expanded use, awareness and understanding of adverse reactions to biologicals have also increased. Herein, we discuss the pathomechanism of adverse reactions to biological agents used to treat skin conditions and apply these to Pichler's classification system. This classification differentiates five distinct types, namely overstimulation (type α), hypersensitivity or immunogenicity (β), immunodeviation (γ), cross‐reactivity (δ) and nonimmunologic adverse reactions (ε). This classification covers most types of adverse reactions associated with use of biological agents and could be used to better understand the reaction pathogenesis and manage the clinical features of biological adverse effects.

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Rituximab induced cytokine release syndrome in an MS patient: A case report

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 3 publications

References 19 publications

Stability Analysis in a Mathematical Model for Allergic Reactions

Stability Analysis in a Mathematical Model for Allergic Reactions

Rituximab

Pathomechanism of Adverse Reactions to Biological Treatment of Inflammatory Skin Conditions

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