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Pediatric Nephrology

, Volume 28, Issue 9, pp 1875–1879 | Cite as

Fulminant viral myocarditis after rituximab therapy in pediatric nephrotic syndrome

  • Anne-Laure Sellier-Leclerc
  • Emre Belli
  • Valérie Guérin
  • Peter Dorfmüller
  • Georges Deschênes
Brief Report

Abstract

Background

We report a 7-year-old boy with high-degree steroid-dependent idiopathic nephrotic syndrome (SDNS) who went into remission with rituximab (RTX) maintenance therapy.

Case-Diagnosis/Treatment

Four months after this patient received his first RTX infusion, there was a progressive and sustained decrease of immunoglobulin (Ig)G and IgM levels. Thirteen months after the initiation of RTX therapy he was in sustained remission without any steroid or oral immunosuppressive therapy; however, B cell depletion was still present. At this time he developed a fulminant myocarditis due to enterovirus. Despite aggressive treatment and the administration of intravenous polyvalent immunoglobulins there was no clinical improvement. He successfully underwent heart transplant surgery.

Conclusions

We conclude that B cell depletion with RTX is efficacious in the treatment of paediatric SDNS but that it may be associated with severe infectious complications. Therefore, we recommend a close monitoring of Ig levels in children who have received RTX therapy and a supplementation with intravenous Ig as soon as the Ig levels fall below the lower limit of the normal range

Keywords

Idiopathic nephrotic syndrome Rituximab B cell depletion Hypogammaglobulinemia Fulminant myocarditis 

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Copyright information

© IPNA 2013

Authors and Affiliations

  • Anne-Laure Sellier-Leclerc
    • 1
  • Emre Belli
    • 2
  • Valérie Guérin
    • 3
  • Peter Dorfmüller
    • 4
  • Georges Deschênes
    • 5
    • 6
  1. 1.Department of Pediatric Nephrology, Hôpital Femme-Mère-Enfants Hospices Civils de LyonBronFrance
  2. 2.Department of Pediatric CardiologyCentre Chirurgical Marie LannelongueLe Plessis-Robinson, ParisFrance
  3. 3.Laboratory of Immunology, Robert Debré HospitalAssistance Publique Hôpitaux de ParisParisFrance
  4. 4.Department of Anathomo-pathologyCentre Chirurgical Marie LannelongueLe Plessis-Robinson, ParisFrance
  5. 5.Department of Pediatric Nephrology, Robert Debré HospitalAssistance Publique Hôpitaux de ParisParisFrance
  6. 6.University Denis DiderotParis 7France

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