Delayed Onset of Acute Respiratory Distress Syndrome Following Intravenous Rituximab in a Rheumatoid Arthritis Patient: A Case Report

Rituximab是一種人工合成的單株抗體能安全有效的治療惡性淋巴瘤和以B淋巴球為主的自體免疫疾病，如類風濕性關節炎。大部分的副作用僅是輕微的表現，包括感冒症狀、發燒、畏寒、咳嗽和鼻炎。不過也有一些較嚴重的病例報告，如間質性肺炎、肋膜炎、支氣管痙攣和急性呼吸窘迫症。我們報告的這位類風濕性關節炎女性在標準的藥物治療無效下使用Rituximab靜脈注射治療。不幸的患者在接受第二劑注射的18天後，病人發生漸進性的呼吸困難結果造成呼吸衰竭。最後的診斷歸咎於延遲性的藥物過敏反應造成急性呼吸窘迫症。因此我們在使用Rituximab必須留意可能產生的副作用，儘管是一些罕見或是延遲發生的症狀。我們回顧並整理過去的相關文獻提出此報告。

關鍵字

急性呼吸窘迫症；延遲性過敏反應；類風濕性關節炎； Rtuximab

並列摘要

Rituximab is a humanized monoclonal antibody found to be effective and safe in its use with malignant lymphoma and various humoral autoimmune diseases in which B lymphocytes play a role, such as rheumatoid arthritis. Most of the adverse events are modest, including flu-like illness, fever, chills, cough and rhinitis. However, more serious adverse effects have been reported, such as interstitial pneumonitis, pleuritis, bronchospasm and acute respiratory distress syndrome. We report a woman with rheumatoid arthritis who was treated with intravenous rituximab because her symptoms were refractory to standard treatment that included cyclosporine, methotrexate and steroid pulse therapy. Unfortunately, she suffered progressive dyspnea resulting in acute respiratory failure 18 days after the second administration. She was subsequently diagnosed with acute respiratory distress syndrome (ARDS), and this was attributed to a delayed hypersensitivity reaction to the medicine. It is important to keep in mind that rituximab may induce this fatal adverse effect, even though it is rare and delayed in its onset.

並列關鍵字

acute respiratory distress syndrome ； delayed hypersensitivity reaction ； rheumatoid arthritis ； rituximab

國際替代計量

Delayed Onset of Acute Respiratory Distress Syndrome Following Intravenous Rituximab in a Rheumatoid Arthritis Patient: A Case Report

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