Pasquet Florian, Combarnous François, Macgregor Brigitte, Coppere Brigitte, Mausservey Christelle, Ninet Jacques, Hot Arnaud
Department of Internal Medicine, Hôpital Edouard Herriot, Lyon, France.
J Med Case Rep. 2012 Jan 27;6:39. doi: 10.1186/1752-1947-6-39.
Systemic B-cell depletion and clinical remission of the systemic effects of cryoglobulins have already been achieved using rituximab in hepatitis C virus-positive immunocompetent patients. Conversely, to the best of our knowledge there are no reports in the literature regarding the use of rituximab in hepatitis B virus-associated cryoglobulinemia.
We report here the case of a 60-year-old Caucasian man who presented with hepatitis B virus-associated type II cryoglobulinemia with severe multisystem disease, including membranoproliferative glomerulonephritis with acute renal failure. The vasculitis was refractory to conventional and antiviral therapy but rituximab use led to a fall in cryoglobulin levels and disease control. The B-cell depletion was safe and efficient to induce a complete remission of the disease.
Our case highlights the benefit and the efficacy of rituximab in association with antiviral therapy in small vessel vasculitis related to hepatitis B virus-associated mixed cryoglobulinemia.
在丙型肝炎病毒阳性的免疫功能正常患者中，使用利妥昔单抗已实现全身性B细胞耗竭以及冷球蛋白血症全身效应的临床缓解。相反，据我们所知，文献中尚无关于利妥昔单抗用于乙型肝炎病毒相关冷球蛋白血症的报道。
我们在此报告一名60岁的白种男性患者，他患有乙型肝炎病毒相关的II型冷球蛋白血症，并伴有严重的多系统疾病，包括伴有急性肾衰竭的膜增生性肾小球肾炎。该血管炎对传统治疗和抗病毒治疗均无效，但使用利妥昔单抗导致冷球蛋白水平下降并控制了疾病。B细胞耗竭安全有效，可使疾病完全缓解。
我们的病例突出了利妥昔单抗联合抗病毒治疗在与乙型肝炎病毒相关的混合性冷球蛋白血症相关的小血管血管炎中的益处和疗效。
