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

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.