Rituximab-induced interstitial lung disease.

Area of Science:

• Pulmonology
• Rheumatology
• Oncology

Background:

• Rituximab is a chimeric monoclonal antibody used in treating various autoimmune diseases and cancers.
• Interstitial lung disease (ILD) is a known, albeit rare, adverse effect associated with rituximab therapy, termed R-ILD.
• The precise pathogenesis and clinical spectrum of R-ILD require further elucidation.

Observation:

• A review of 16 reported cases of R-ILD, including two new cases, identified commonalities in patient demographics, clinical presentations, and diagnostic findings.
• Common features include older patient age, specific clinical symptoms (dyspnea, fever, cough), characteristic findings on computed tomography (CT) scans, pulmonary function tests, and lung biopsies.
• Therapeutic interventions primarily involved corticosteroids and broad-spectrum antibiotics.

Findings:

• R-ILD presents with a variable prognosis, with patients showing poor outcomes despite corticosteroid treatment.
• The exact pathogenesis of R-ILD remains largely unknown, with theories suggesting the induction and release of cytotoxic substances.
• Key diagnostic indicators include dyspnea, fever, and cough in patients receiving rituximab, especially when infection is not evident.

Implications:

• R-ILD represents a significant, potentially fatal pulmonary toxicity that necessitates clinical vigilance.
• Healthcare providers should consider R-ILD in patients presenting with relevant respiratory symptoms post-rituximab therapy.
• Prompt diagnosis and initiation of corticosteroid treatment are critical for managing R-ILD and improving patient prognosis.