PDF(Pubmed)
Abstract：
Management of refractory immune thrombocytopenia frequently involves rituximab, a chimeric anti-CD20 monoclonal antibody, to target B cells and induce remission in most patients. However, neutralizing antibodies to rituximab that nullify therapeutic response and may lead to serum sickness have been rarely reported. Here, we present a case of a young adult woman with Evans syndrome treated with rituximab, complicated by the development of serum sickness, acute respiratory distress syndrome, and platelet refractoriness presumed secondary to neutralizing antibodies to rituximab. She was successfully treated with the humanized anti-CD20 monoclonal antibody, obinutuzumab, with subsequent symptom resolution. Additionally, a review of 10 previously published cases of serum-sickness associated with the use of rituximab for idiopathic thrombocytopenic purpura (ITP) is summarized. This case highlights that recognition of more subtle or rare symptoms of rituximab-induced serum sickness is important to facilitate rapid intervention.
摘要：
难治性免疫性血小板减少症的治疗通常涉及利妥昔单抗，嵌合抗CD20单克隆抗体，靶向B细胞并在大多数患者中诱导缓解。然而,利妥昔单抗的中和抗体使治疗反应无效并可能导致血清病的报道很少。这里,我们介绍了一个年轻的成年女性，患有伊凡综合征，接受利妥昔单抗治疗，复杂的血清病的发展，急性呼吸窘迫综合征,和血小板难治性推测继发于利妥昔单抗的中和抗体。她成功用人源化抗CD20单克隆抗体治疗，奥比努珠单抗，随后的症状解决。此外,本综述总结了10例先前发表的与利妥昔单抗治疗特发性血小板减少性紫癜(ITP)相关的血清病病例.这种情况突出表明，识别利妥昔单抗引起的血清病的更微妙或罕见的症状对于促进快速干预很重要。
