Related Experiment Videos
Fulminant viral myocarditis after rituximab therapy in pediatric nephrotic syndrome
Anne-Laure Sellier-Leclerc1, Emre Belli, Valérie Guérin
1Department of Pediatric Nephrology, Hôpital Femme-Mère-Enfants, Hospices Civils de Lyon, Bron, France.
Background:
We report a 7-year-old boy with high-degree steroid-dependent idiopathic nephrotic syndrome (SDNS) who went into remission with rituximab (RTX) maintenance therapy.
Case-Diagnosis/Treatment:
Four months after this patient received his first RTX infusion, there was a progressive and sustained decrease of immunoglobulin (Ig)G and IgM levels. Thirteen months after the initiation of RTX therapy he was in sustained remission without any steroid or oral immunosuppressive therapy; however, B cell depletion was still present. At this time he developed a fulminant myocarditis due to enterovirus. Despite aggressive treatment and the administration of intravenous polyvalent immunoglobulins there was no clinical improvement. He successfully underwent heart transplant surgery.
Conclusions:
We conclude that B cell depletion with RTX is efficacious in the treatment of paediatric SDNS but that it may be associated with severe infectious complications. Therefore, we recommend a close monitoring of Ig levels in children who have received RTX therapy and a supplementation with intravenous Ig as soon as the Ig levels fall below the lower limit of the normal range.
Related Concept Videos
Myocarditis III: Medical Management
Myocarditis II: Clinical Features and Diagnostic Tests
Rheumatic Heart Disease I: Introduction
Myocarditis IV: Nursing Management
Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
Nephrotic Syndrome II : Assessment and Medical Management