Case Report on Adverse Events Associated With...

Case Report on Adverse Events Associated With Use of Rituximab

Author Name : Syeda Tazheen Fatima, Syeda Juveriya Amreen, K. Sindhuja, Ramya Bala Prabha. G

ABSTRACT

Rituximab is a CD20 monoclonal antibody that is a hybrid of human and murine origin that depletes B cells by triggering apoptosis and immune-mediated cytotoxicity in the cells. It has a long-lasting effect on B-cell counts and decreases the amount of circulating antibodies. Rituximab therapy normally results in a recovery of B lymphocyte levels within 6 to 12 months, but few studies have proven long-term immunological reconstitution in children after treatment with the drug, particularly across the drug's wide range of applications. A 19 year old female admitted to the hospital with complaints of painful raw areas all over her body since 5 months, burning sensation while eating. Also with a history of burning sensation and redness in eyes over longer period. On examination the patient was afebrile, RR- 20/min, PR- 80 bpm, BP- 110/80 mm of Hg, SPO₂- 98%, Thyroid levels (Total T3 = 1.01, Total T4 = 9.30, TSH = 2.103), Hemoglobin – 11.7 g%, RBC Count – 4  million/mm³, WBC Count – 16,200 /mm³, Platelet count – 2.3/mm³, PCV- 32.6%, MCV- 84.7 FL, MCH – 30.3 picogram/cell. On Day 5 of admission, the patient was administered with Injection Rituximab, which is a biologic drug recommended for autoimmune disease. Unit dose was 1000 mg, administered through 500 ml Normal saline. Immediately after administration of Rituximab, the patient showed symptoms like high basal body temperature, chills, ECG variation, Tachycardia and insomnia within the first day of administration of Rituximab. However, widespread usage of rituximab has increased the number of HSRs. There are several proposed classes for HSRs to mAbs, including rituximab, some of which overlap. Its own course and management. For a therapeutic perspective, the new proposed classification seems to have clinical implications.

Keywords: Adverse Drug Reaction, Rituximab, Hypersensitivy reactions, exogenous Cushing’s syndrome, Pemphigus vulgaris.