Lamprecht P, Lerin-Lozano C, Merz H, Dennin R H, Gause A, Voswinkel J, Peters S O, Gutzeit O, Arlt A C, Solbach W, Gross W L
Department of Rheumatology, University Hospital of Schleswig-Holstein, Campus Luebeck, and Rheumaklinik Bad Bramstedt, Ratzeburger Allee 160, 23538 Luebeck, Germany.
Ann Rheum Dis. 2003 Dec;62(12):1230-3. doi: 10.1136/ard.2002.004929.
To report the successful induction of remission with the monoclonal anti-CD20 antibody rituximab in a patient with hepatitis C virus (HCV) associated cryoglobulinaemic vasculitis and a non-Hodgkin's lymphoma (NHL) resistant to previously advocated conventional treatments.
The patient was a 45 year old woman with HCV associated cryoglobulinaemic vasculitis, with purpura, arthralgia, constitutional symptoms, and a polyneuropathy. A malignant NHL was found as underlying lymphoproliferative disease. At this stage the disease was refractory to interferon alpha2b and ribavirin and to subsequent immunosuppressive treatment with cyclophosphamide. Six rituximab infusions targeting the CD20 antigen on cells of the B cell lineage induced remission of the vasculitis. Bone marrow biopsy disclosed absence of the NHL. Remission has subsequently been maintained and HCV eliminated with the new pegylated interferon alpha2b and ribavirin for nearly one year.
Transition of the underlying "benign" lymphoproliferative disease to a malignant lymphoma may result in difficult to treat HCV associated cryoglobulinaemic vasculitis. Rituximab offers a new possibility for inducing remission in refractory HCV associated cryoglobulinaemic vasculitis and the lymphoproliferative disorder. After remission, HCV may subsequently be eliminated with pegylated interferon alpha2b and ribavirin.
报告1例丙型肝炎病毒（HCV）相关冷球蛋白血症性血管炎合并对先前提倡的传统治疗耐药的非霍奇金淋巴瘤（NHL）患者，使用单克隆抗CD20抗体利妥昔单抗成功诱导缓解。
患者为一名45岁女性，患有HCV相关冷球蛋白血症性血管炎，伴有紫癜, 关节痛, 全身症状和多发性神经病。发现潜在的淋巴增殖性疾病为恶性NHL。在此阶段，该疾病对干扰素α2b和利巴韦林以及随后的环磷酰胺免疫抑制治疗均无效。针对B细胞系细胞上的CD20抗原进行6次利妥昔单抗输注可诱导血管炎缓解。骨髓活检显示无NHL。随后病情缓解得以维持，并且使用新的聚乙二醇化干扰素α2b和利巴韦林消除HCV近一年。
潜在的“良性”淋巴增殖性疾病转变为恶性淋巴瘤可能导致难以治疗的HCV相关冷球蛋白血症性血管炎。利妥昔单抗为诱导难治性HCV相关冷球蛋白血症性血管炎和淋巴增殖性疾病缓解提供了新的可能性。缓解后，随后可使用聚乙二醇化干扰素α2b和利巴韦林消除HCV。
