Finger Eduardo, Scheinberg Morton
Hospital Israelita Albert Einstein and Albert Einstein Research Institute, São Paulo, Brazil, CEP 05652-900.
J Clin Rheumatol. 2007 Apr;13(2):94-5. doi: 10.1097/01.rhu.0000262585.18582.1e.
Rituximab is a monoclonal antibody that depletes B cells and is commonly used for the treatment of autoimmune diseases. In this report, we describe 2 patients with autoimmune diseases and marked hypergammaglobulinemia attending at a tertiary care hospital, who, following treatment with rituximab, developed a severe serum-sickness-like reactions. Both patients were treated with intravenous corticosteroids, recovered well, and on follow-up, were negative for the development of human antichimeric antibodies. Based on these and other similar cases in the literature, we propose that severe hypergammaglobulinemia due to autoimmune conditions may be a predisposing factor for the development of a serum sickness-like reaction after treatment with Rituximab, which can sometimes occur without prior exposure to this antibody. Rheumatologists should be aware of this possible association when prescribing this medication.
利妥昔单抗是一种可消耗B细胞的单克隆抗体，常用于治疗自身免疫性疾病。在本报告中，我们描述了2例在三级医疗中心就诊的自身免疫性疾病伴显著高球蛋白血症患者，他们在接受利妥昔单抗治疗后发生了严重的血清病样反应。两名患者均接受了静脉注射皮质类固醇治疗，恢复良好，随访时人抗嵌合抗体检测为阴性。基于这些病例及文献中的其他类似病例，我们提出，自身免疫性疾病导致的严重高球蛋白血症可能是利妥昔单抗治疗后发生血清病样反应的一个易感因素，这种反应有时可能在未预先接触该抗体的情况下发生。风湿病学家在开具此药物处方时应意识到这种可能的关联。
