The case of Kawasaki disease after rituximab infusion triggered by human anti-chimeric antibodies.

CEN Case Reports
Masayuki SatoHirotsugu Kitayama

Abstract

Rituximab (RTX) is an effective treatment for refractory nephrotic syndrome (NS), but may produce human anti-chimeric antibodies (HACA) which can cause severe infusion reaction or rituximab-induced serum sickness (RISS). RISS presents with a fever, rash, and arthralgia, which typically occurs 7-21 days after RTX infusion. On the other hand, Kawasaki disease (KD) also presents with fever and rash. There have been no reports of KD developed after RTX infusion. A 6-year-old girl with frequently relapsing NS was admitted to our hospital for fever and rash on day 7 after receiving RTX. Although it was suggestive of RISS at first, she also had conjunctival hyperemia, swelling, and erythema of the hands and feet, and a right coronary artery abnormality on echocardiography. Her symptoms met the diagnostic criteria of KD. We administered intravenous immunoglobulin (IVIg) (2 g/kg), and her symptoms resolved within a few days. The HACA titer determined using the serum collected at admission was very high. This is the first report of KD with a clinical course similar to RISS. It should be noted that a careful follow-up of coronary arteries should be performed in patients suspected of RISS.

References

Jan 1, 1985·Pediatric Infectious Disease·W H MasonB Bernstein
Oct 1, 1983·European Journal of Pediatrics·A Furuse, I Matsuda
May 11, 2011·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Shuichi ItoKazumoto Iijima
Jul 23, 2015·Seminars in Arthritis and Rheumatism·Paras KarmacharyaClifton O Bingham
Mar 31, 2017·Circulation·Brian W McCrindleUNKNOWN American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Di
Jan 26, 2020·BMJ Case Reports·Manuel Alfredo PodestàPiero Ruggenenti

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