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Rituximab-induced serum sickness in a 6-year-old boy with steroid-dependent nephrotic syndrome

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Abstract

Rituximab (RTX) is a murine–human chimeric monoclonal antibody against CD20 that has been proven effective for preventing relapse in frequently-relapsing or steroid-dependent nephrotic syndrome (NS). Serum sickness, a type-3 hypersensitivity reaction resulting from injection of foreign proteins, has been reported in patients treated with RTX. Herein, we describe a case of RTX-induced serum sickness (RISS) in a 6-year-old boy with steroid-dependent NS. He presented to the hospital with fever and polyarthralgia at 10 days after his fourth dose of RTX. Although he was started on empiric intravenous antibiotics, there was no evidence of septic arthritis and his symptoms resolved over the course of 4 days. He was diagnosed with RISS based on the chronology of RTX administration and the acute-onset self-limiting course of the polyarthritis. His serum human anti-chimeric antibody (HACA) level on day 53 exceeded the limit of quantification (5000 ng/mL). The pathogenesis of RISS and the role of HACAs remain unclear. It is important for clinicians to recognize RISS, because further infusions of RTX may cause more severe reactions in patients with a history of RISS.

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Acknowledgements

We gratefully acknowledge the hospital staff for their help and support.

The authors thank Alison Sherwin, PhD, from Edanz Group (https://en-author-services.edanzgroup.com/) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Pediatrics, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Misako Nakamura, Shoichiro Kanda, Yuya Yoshioka, Chie Takahashi, Keiho Owada, Yuko Kajiho, Yutaka Harita & Akira Oka

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  1. Misako Nakamura
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  2. Shoichiro Kanda
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  3. Yuya Yoshioka
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  4. Chie Takahashi
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  5. Keiho Owada
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  6. Yuko Kajiho
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  7. Yutaka Harita
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  8. Akira Oka
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Correspondence to Shoichiro Kanda.

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Nakamura, M., Kanda, S., Yoshioka, Y. et al. Rituximab-induced serum sickness in a 6-year-old boy with steroid-dependent nephrotic syndrome. CEN Case Rep 9, 173–176 (2020). https://doi.org/10.1007/s13730-020-00449-x

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  • DOI: https://doi.org/10.1007/s13730-020-00449-x

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