Successful rituximab therapy in a lupus patient with diffuse alveolar haemorrhage

Abstract

Diffuse alveolar haemorrhage (DAH) is a rare but life-threatening complication of systemic lupus erythematosus (SLE). Specific therapy is based on a heavy immunosuppressive treatment that usually associates corticosteroid and cyclophosphamide boluses and plasma exchange. Despite this treatment, an early mortality rate of 20-50% is reported in the literature. Immunosuppression-related complications are responsible for further mortality and morbidity. Rituximab, a specific anti-CD20 antigen B-cell antibody, has been used with success for the treatment of several refractory autoimmune disorders, but rarely for SLE-induced DAH. We report here the first case of SLE-induced DAH treated successfully with rituximab without cyclophosphamide administration in a patient intolerant to cyclophosphamide. We review the two other cases of SLE-induced DAH managed with rituximab as a part of the immunosuppressive regimen.

Juvenile systemic lupus erythematosus: Review of clinical features and management

“…Despite favourable preliminary reports, clinical trials in adults failed to meet their superiority VOLUME 48 __ NOVEMBER 17, 2011 HABIBI, et al JUVENILE SYSTEMIC LUPUS ERYTHEMATOSUS endpoints [51]. However, it has been found to be effective in patients with refractory nephritis, hematological disease and alveolar haemorrhage [52,53]. There are no randomized controlled trials on the use of this drug in pediatric SLE.…”

Allogeneic transplantation of umbilical cord-derived mesenchymal stem cells for diffuse alveolar hemorrhage in systemic lupus erythematosus

“…Plasmapheresis may be useful for patients who are not responsive to the above regimens [8]. In recent years, SLE-associated DAH treated successfully with rituximab without CYC administration has been reported in some cases, but lacks larger-scale clinical studies [9][10][11].…”

Rituximab: an emerging treatment for recurrent diffuse alveolar hemorrhage in systemic lupus erythematosus

“…However, previous cases have demonstrated successful clinical response when rituximab is initiated early in the hospital course prior to cyclophosphamide use 3 or when rituximab is used alone because of cyclophosphamide intolerance. 4 The promising results of these cases, in addition to cyclophosphamide's potential toxicity to our patient given her pancytopenia, drove us to use rituximab instead of cyclophosphamide. Importantly, the combination of pulse-dose steroids, cyclophosphamide, and plasma exchange nonspecifically targets both the B-and T-cell branches of the immune system.…”