Rituximab-induced Severe Pulmonary Disease

Rituximab has been widely used to treat CD20+ B-cell lymphoma for more than ten years. Its safety and tolerability are well established on the basis of data from more than one million patients worldwide. The side effects are usually mild, and mostly are infusion-related reactions (IRRs) such as fever and chills. IRRs can be prevented by slow administration and some premedication. However, rituximab-induced severe pulmonary disease is still occasionally reported, with an occurrence rate of 0.01-0.03%. We herein report a 77-year-old man who presented with interstitial pneumonitis and respiratory failure soon after the second infusion of rituximab. Cytokines may play an important role in the pathogenesis of rituximab-related complications. Such side effects may be prevented by appropriate cytoreduction of the tumor and premedication with steroids.