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Rituximab-induced serum sickness in a girl with nephrotic syndrome

Yuka Kimura1, Kyoko Kiyota1, Mayo Ikeuchi1

  • 1Department of Pediatrics, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan.

CEN Case Reports
|May 20, 2022
PubMed

Rituximab (RTX) has been used to treat B cell lineage lymphoma/leukemia or autoimmune or autoinflammatory disorders. RTX therapy has been extensively applied to cases of frequently relapsing nephrotic syndrome (FRNS) and steroid-dependent nephrotic syndrome. Rituximab-induced serum sickness (RISS) has been recognized as a rare severe type-3 hypersensitivity reaction in patients treated with RTX. We herein report a 10-year-old girl with RISS in FRNS. She was diagnosed with RISS based on characteristic symptoms, such as a fever, rash, arthritis, or proteinuria, during RTX therapy associated with a high level of human anti-chimeric antibody. Even after recovering from acute symptoms by RISS, she suffered from worsening relapses of nephrotic syndrome. The symptoms of RISS are non-specific, resembling viral infections, autoinflammatory diseases and Kawasaki disease, especially in children. While RISS is a rare complication among patients with nephrotic syndrome, it should be carefully considered as a severe complication in patients being treated with RTX.

Keywords:
Frequency relapse nephrotic syndromeHuman anti-chimeric antibodyRituximab-induced serum sicknessSteroid-dependent nephrotic syndrome

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