Calderazzo Massimo, Rende Pierandrea, Gambardella Paolo, De Sarro Giovambattista, Gallelli Luca
Department of Infectious Disease, ASP Lamezia Terme, Catanzaro, Italy.
Department of Health Science, University of Catanzaro, Viale Europa, Catanzaro, Italy.
Drug Saf Case Rep. 2015 Dec;2(1):8. doi: 10.1007/s40800-015-0010-8.
A 44-year-old male developed interstitial lung disease (ILD) during treatment with rituximab (375 mg/m weekly intravenous × 4 weeks) for the management of immune thrombocytopenia (ITP). After 1 month of treatment he developed dyspnea, fever (38.9 °C), an increase of C-reactive protein (CRP) and white blood cells with hypoxemia, and decreased platelets. Chest X-ray and high-resolution computed tomography revealed diffuse bilateral lung infiltrates. He was diagnosed with severe ILD; rituximab was discontinued, and treatment with fluticasone combined with salmeterol, methylprednisolone, and omeprazole was started, with an improvement of symptoms over 15 days with normalization in CRP at 30 days. A Naranjo assessment score of 6 was obtained, indicating a probable relationship between the patient's symptoms and the suspect drug. In conclusion, in ITP patients treated with rituximab, we suggest evaluating pulmonary endpoints through pharmaco-epidemiological observational studies.
一名44岁男性在使用利妥昔单抗（375mg/m²，每周静脉注射，共4周）治疗免疫性血小板减少症（ITP）期间发生了间质性肺病（ILD）。治疗1个月后，他出现呼吸困难、发热（38.9°C）、C反应蛋白（CRP）升高、白细胞增多伴低氧血症，血小板减少。胸部X线和高分辨率计算机断层扫描显示双侧肺部弥漫性浸润。他被诊断为重度ILD；停用利妥昔单抗，并开始使用氟替卡松联合沙美特罗、甲泼尼龙和奥美拉唑治疗，15天内症状改善，30天时CRP恢复正常。Naranjo评估评分为6分，表明患者症状与可疑药物之间可能存在关联。总之，对于接受利妥昔单抗治疗的ITP患者，我们建议通过药物流行病学观察性研究评估肺部终点指标。
