Qureini Aref, Asif Samia, Harry Stephanie, Madhusudhana Sheshadri
Department of Internal Medicine, University of Missouri School of Medicine, Kansas City, MO, USA.
Department of Hematology and Oncology, University of Missouri School of Medicine, Kansas City, MO, USA.
Am J Case Rep. 2019 Sep 21;20:1394-1397. doi: 10.12659/AJCR.917644.
BACKGROUND Rituximab is a chimeric monoclonal antibody to CD20 that is used to treat vasculitis, B-cell lymphoproliferative disorders, and B-cell non-Hodgkin lymphoma (NHL). A report is presented of a case of rituximab-induced acute thrombocytopenia (RIAT) in a woman with splenic marginal zone lymphoma (SMZL) and chronic hepatitis C virus (HCV) infection. CASE REPORT A 46-year-old woman with SMZL complicated by chronic HCV infection presented with worsening B symptoms of fever, night sweats, and loss of weight. The patient had a history of recreational drug use. Intravenous treatment with rituximab (dose, 375 mg/m²) commenced with close monitoring in hospital. On the following day, the complete blood count (CBC) showed that her platelet count had dropped from her admission level of 167,000/μl to 7,000/μl, with no change in hemoglobin or white blood cell (WBC) levels. A diagnosis of RIAT was made. The patient was managed conservatively and monitored for the development of potential clinical complications. CONCLUSIONS RIAT is a rare complication of treatment with rituximab and may be poorly recognized. Further studies are needed to determine the incidence and causes of thrombocytopenia in patients treated with rituximab and the possible association with chronic viral infections, including HCV.
利妥昔单抗是一种针对CD20的嵌合单克隆抗体，用于治疗血管炎、B细胞淋巴增殖性疾病和B细胞非霍奇金淋巴瘤（NHL）。本文报告了一例患有脾边缘区淋巴瘤（SMZL）和慢性丙型肝炎病毒（HCV）感染的女性发生利妥昔单抗诱导的急性血小板减少症（RIAT）的病例。病例报告：一名患有SMZL并伴有慢性HCV感染的46岁女性，出现发热、盗汗和体重减轻等B症状加重。该患者有使用消遣性药物的病史。在医院密切监测下开始静脉注射利妥昔单抗（剂量为375 mg/m²）。次日，全血细胞计数（CBC）显示她的血小板计数从入院时的167,000/μl降至7,000/μl，血红蛋白和白细胞（WBC）水平无变化。诊断为RIAT。对该患者进行了保守治疗，并监测潜在临床并发症的发生。结论：RIAT是利妥昔单抗治疗的一种罕见并发症，可能未得到充分认识。需要进一步研究以确定接受利妥昔单抗治疗患者血小板减少症的发生率和原因，以及与包括HCV在内的慢性病毒感染的可能关联。
