Pediatric Nephrology

, Volume 24, Issue 9, pp 1753–1755 | Cite as

Fatal pulmonary fibrosis after rituximab administration

  • Marie-Camille Chaumais
  • Arnaud Garnier
  • François Chalard
  • Michel Peuchmaur
  • Stephane Dauger
  • Evelyne Jacqz-Agrain
  • Georges Deschênes
Brief Report


Idiopathic nephrotic syndrome is the most frequent glomerular disease during childhood. Although immunosuppressive agents are usually effective, some severe cases remain difficult to treat. We describe a female patient with secondary steroid-resistant nephrotic syndrome who no longer responded to conventional treatment. Owing to cyclosporine toxicity, rituximab was administered. Three days after treatment the patient’s clinical condition dramatically worsened and she developed acute respiratory distress. Despite all means used to treat her, she died 5 weeks after rituximab infusion. A pulmonary biopsy showed extensive fibrosis, while the alveolar epithelium was no longer visible.


Nephrotic syndrome Prednisone Cyclosporine Children Virus 


  1. 1.
    Tune BM, Mendoza SA (1997) Treatment of the idiopathic nephrotic syndrome: regimens and outcomes in children and adults. J Am Soc Nephrol 8:824–832PubMedGoogle Scholar
  2. 2.
    Bagga A, Sinha A, Moudgil A (2007) Rituximab in patients with the steroid-resistant nephrotic syndrome. N Engl J Med 356:2751–2752PubMedCrossRefGoogle Scholar
  3. 3.
    Gilbert RD, Hulse E, Rigden S (2006) Rituximab therapy for steroid-dependent minimal change nephrotic syndrome. Pediatr Nephrol 21:1698–1700PubMedCrossRefGoogle Scholar
  4. 4.
    Suri M, Tran K, Sharma AP, Filler G, Grimmer J (2008) Remission of steroid-resistant nephrotic syndrome due to focal and segmental glomerulosclerosis using rituximab. Int Urol Nephrol 40:807–810PubMedCrossRefGoogle Scholar
  5. 5.
    Benz K, Dötsch J, Rascher W, Stachel D (2004) Change of the course of steroid-dependent nephrotic syndrome after rituximab therapy. Pediatr Nephrol 19:794–797PubMedCrossRefGoogle Scholar
  6. 6.
    Pescovitz MD, Book BK, Sidner RA (2006) Resolution of recurrent focal segmental glomerulosclerosis proteinuria after rituximab treatment. N Engl J Med 354:1961–1963PubMedCrossRefGoogle Scholar
  7. 7.
    Genentech report (2003) Rituximab and pulmonary events, 2003Google Scholar
  8. 8.
    Montero AJ, McCarthy JJ, Chen G, Rice L (2005) Acute respiratory distress syndrome after rituximab infusion. Int J Hematol 82:324–326PubMedCrossRefGoogle Scholar
  9. 9.
    Alexandrescu DT, Dutcher JP, O’Boyle K, Albulak M, Oiseth S, Wiernik PH (2004) Fatal intra-alveolar hemorrhage after rituximab in a patient with non-Hodgkin lymphoma. Leuk Lymphoma 45:2321–2325PubMedCrossRefGoogle Scholar
  10. 10.
    Burton C, Kaczmarski R, Jan-Mohamed R (2003) Interstitial pneumonitis related to rituximab therapy. N Engl J Med 26:2690–2691; discussion 2690–2691CrossRefGoogle Scholar
  11. 11.
    Heresi GA, Farver CF, Stoller JK (2008) Interstitial pneumonitis and alveolar hemorrhage complicating use of rituximab. Case report and review of the literature. Respiration 76:449–453PubMedCrossRefGoogle Scholar
  12. 12.
    Swords R, Power D, Fay M, O’Donnell R, Murphy PT (2004) Interstitial pneumonitis following rituximab therapy for immune thrombocytopenic purpura (ITP). Am J Hematol 77:103–104PubMedCrossRefGoogle Scholar
  13. 13.
    Herishanu Y, Polliack A, Leider-Trejo L, Grieff Y, Metser U, Naparstek E (2006) Fatal interstitial pneumonitis related to rituximab-containing regimen. Clin Lymphoma Myeloma 6:407–409PubMedCrossRefGoogle Scholar
  14. 14.
    Leon RJ, Gonsalvo A, Salas R, Hidalgo NC (2004) Rituximab-induced acute pulmonary fibrosis (letter). Mayo Clin Proc 79:949–953PubMedCrossRefGoogle Scholar
  15. 15.
    Wagner SA, Mehta AC, Laber DA (2007) Rituximab-induced interstitial lung disease. Am J Hematol 82:916–919PubMedCrossRefGoogle Scholar

Copyright information

© IPNA 2009

Authors and Affiliations

  • Marie-Camille Chaumais
    • 1
  • Arnaud Garnier
    • 2
  • François Chalard
    • 3
  • Michel Peuchmaur
    • 4
  • Stephane Dauger
    • 5
  • Evelyne Jacqz-Agrain
    • 1
  • Georges Deschênes
    • 2
  1. 1.Department of Pediatric Pharmacology and PharmacogeneticsRobert Debré HospitalParisFrance
  2. 2.Department of Pediatric NephrologyRobert Debré HospitalParis Cedex 19France
  3. 3.Department of ImageryRobert Debré HospitalParisFrance
  4. 4.Department of AnatomopathologyRobert Debré HospitalParisFrance
  5. 5.Department of Pediatric Intensive CareRobert Debré HospitalParisFrance

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