Asan Furkan, Sayar Zeynep Esin, Karadeniz Kagan Gokdeniz, Turk Bengi Gul, Saip Sabahattin
Department of Neurology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, TUR.
Cureus. 2024 Oct 14;16(10):e71412. doi: 10.7759/cureus.71412. eCollection 2024 Oct.
During or after rituximab treatment, various serious side effects may occur. Cerebrovascular diseases are relatively limited among these side effects, and whether they are contingent on rituximab treatment is unclear. This case report highlights an unusual and severe event after rituximab treatment. Our patient was a 32-year-old female diagnosed with primary angiitis of the central nervous system (PACNS). Despite meticulous management with azathioprine, the patient's condition exhibited persistent ischemic activity, necessitating a therapeutic shift to rituximab. Regrettably, very soon after the initial rituximab infusion, a substantial acute ischemic stroke took place in the right cerebral hemisphere. We have interpreted that the significant stenosis in the right internal carotid artery, which had developed due to PACNS, may pose a risk for the development of acute ischemia in our patient after rituximab treatment. In conclusion, careful evaluation of rituximab treatment may be appropriate in patients with serious stenosis of intracranial major arteries.
在利妥昔单抗治疗期间或之后，可能会出现各种严重的副作用。在这些副作用中，脑血管疾病相对较少见，且它们是否取决于利妥昔单抗治疗尚不清楚。本病例报告强调了利妥昔单抗治疗后发生的一起罕见且严重的事件。我们的患者是一名32岁女性，被诊断为中枢神经系统原发性血管炎（PACNS）。尽管使用硫唑嘌呤进行了精心治疗，但患者的病情仍表现出持续的缺血活动，因此需要转而使用利妥昔单抗进行治疗。遗憾的是，在首次输注利妥昔单抗后不久，患者右侧大脑半球发生了大面积急性缺血性中风。我们认为，由于PACNS导致的右侧颈内动脉严重狭窄，可能是我们的患者在接受利妥昔单抗治疗后发生急性缺血的风险因素。总之，对于颅内主要动脉严重狭窄的患者，仔细评估利妥昔单抗治疗可能是合适的。
