Rituximab-induced bronchiolitis obliterans organizing pneumonia

Area of Science:

• Pulmonology
• Oncology
• Rheumatology

Background:

• Rituximab-induced lung disease (R-ILD) is a rare but serious adverse event associated with rituximab therapy.
• Common presentations include dyspnea, fever, and cough, often mimicking infection.
• Bronchiolitis Obliterans Organizing Pneumonia (BOOP) is the most frequent clinicopathologic finding in R-ILD.

Purpose of the Study:

• To highlight a case of Bronchiolitis Obliterans Organizing Pneumonia (BOOP) induced by single-agent rituximab.
• To review the literature on the varied presentations and characteristics of rituximab-induced lung disease (R-ILD).
• To increase awareness of this potentially overlooked complication of rituximab treatment.

Main Methods:

• Case presentation of an 82-year-old male with recurrent marginal zone lymphoma treated with rituximab.
• Clinical assessment including computed tomography (CT) imaging and lung biopsy.
• Literature review of rituximab-induced lung disease (R-ILD) and Bronchiolitis Obliterans Organizing Pneumonia (BOOP).

Main Results:

• The patient developed fever, chills, and dyspnea within a week of the first rituximab infusion.
• CT imaging revealed bilateral patchy infiltrates, confirmed as BOOP on biopsy.
• The case demonstrates BOOP as a direct consequence of single-agent rituximab therapy.

Conclusions:

• Rituximab-induced lung disease (R-ILD), particularly BOOP, should be considered in patients with respiratory symptoms post-rituximab.
• Prompt diagnosis and initiation of corticosteroid therapy are essential for managing R-ILD.
• Increased clinical vigilance is necessary to recognize and manage this rare but significant adverse event.