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Rituximab-Induced Serum Sickness Overlapping With Anaphylaxis: A Case Report
Adrien Cottu1,2, Tarik Chaara2, Weniko Caré2,3
1Internal Medicine, Université Pierre et Marie Curie Paris 6, Sorbonne Universités, Paris, FRA.
Cureus
|June 2, 2023
Summary
Serum sickness and anaphylaxis are rare but serious rituximab infusion reactions. This case highlights a patient experiencing both, with confirmed anaphylaxis and elevated tryptase levels alongside serum sickness.
Area of Science:
- Immunology
- Pharmacology
Background:
- Rituximab (RTX) infusions can cause serum sickness (SS) and anaphylaxis.
- SS typically presents 7-14 days post-infusion with fever, rash, and arthralgias.
- Anaphylaxis occurs within hours, characterized by hemodynamic instability, bronchospasm, and rash.
Observation:
- A patient developed serum sickness associated with anaphylaxis five days after their first rituximab infusion of a second course.
- This presentation occurred six days after a third rituximab infusion.
Findings:
- Only eight cases of rituximab-induced serum sickness (RISS) with hemodynamic instability have been documented.
- This report details the first case of proven anaphylaxis with elevated tryptase levels concurrently with RISS.
Implications:
- This case expands the understanding of rituximab infusion reaction timing and presentation.
- It underscores the importance of monitoring for both anaphylaxis and serum sickness following rituximab therapy.
- Further research may be needed to elucidate the mechanisms behind combined RISS and anaphylaxis.
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