Fulminant viral myocarditis after rituximab therapy in pediatric nephrotic syndrome.

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.

• Authors: Anne-Laure Sellier-Leclerc, Emre Belli, Valérie Guérin, Peter Dorfmüller, Georges Deschênes
• Journal: Pediatric nephrology (Berlin, Germany) (Pediatr Nephrol) Vol. 28 Issue 9 Pg. 1875-9 (Sep 2013) ISSN: 1432-198X [Electronic] Germany
• PMID: 23700173 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antibodies, Monoclonal, Murine-Derived
• Antigens, CD19
• Immunoglobulin G
• Immunosuppressive Agents
• Rituximab
• Prednisolone

Topics

• Antibodies, Monoclonal, Murine-Derived (adverse effects, therapeutic use)
• Antigens, CD19 (metabolism)
• B-Lymphocytes (drug effects)
• Child
• Flow Cytometry
• Heart Transplantation
• Humans
• Immunoglobulin G (analysis)
• Immunosuppressive Agents (adverse effects, therapeutic use)
• Male
• Myocarditis (complications, surgery, virology)
• Myocardium (pathology)
• Nephrotic Syndrome (complications, drug therapy)
• Prednisolone (therapeutic use)
• Rituximab