DOI: https://doi.org/10.22141/2307-1257.7.2.2018.127401

Clinical case of successful treatment of Goodpasture syndrome with rituximab

I.Yu. Golovach, O.B. Yaremenko, V.P. Stelmashchuk, T.M. Chipko, A.V. Korochev, E.M. Mikhalchenko, L.V. Mikhalskaya

Abstract


A clinical case of the successful use of rituximab in a patient with severe course of Goodpasture syndrome is described. The patient was admitted to the hospitaal in extremely serious condition with the manifestations of respiratory and renal failure, which required constant respiratory support and hemodialysis. The diagnosis of Goodpasture syndrome was made on the ground of isolated lung and kidney damage as a type of rapidly progressing glomerulonephritis and hemorrhagic alveolitis, high titers of anti-glomerular basement membrane antibo­dies (twice), no increase in the level of other antibodies specific for systemic connective tissue diseases and systemic vasculitis. The patient underwent synchronous pulse therapy with sequential application of cascade plasma filtration, cyclophosphamide and methylprednisolone, without significant improvement. The rationale for the use of rituximab in Goodpasture syndrome was literature data, description of clinical cases, as well as a more than 2-fold increase in CD19+, a high level of anti-glomerular basement membrane antibodies, anemic syndrome and thrombocytopenia, as well as failure of previous immunosuppressive therapy. Therapy with rituximab was performed at a dose of 1000 mg twice with a break of 14 days. A significant improvement in the clinical condition of the patient was noted, as well as restoration of ability to spontaneously breathe, the absence of dyspnoea at rest and on exertion, the absence of hemoptysis, the norma­lization of platelet and hemoglobin indices, the improvement of lung picture on computed tomogram, and a repeated blood test for antibodies to the basal membranes of the glomerular apparatus indicated their absence. Rituximab therapy conducted in the first month after the diagnosis of Goodpasture syndrome contributed to a positive change in the course of the disease, almost complete reversal of lung damage, elimination of life-threate­ning cytopenia and, ultimately, saving of the patient’s life. As in a number of other clinical observations, treatment with ritu­ximab was ineffective in restoring kidney function.


Keywords


Goodpasture syndrome; respiratory failure; renal insufficiency; treatment; rituximab; clinical case

References


Ardashev V, Potehin N, Malysheva S, Borisov A. Goodpasture syndrome. Vrach, 2006;(6):8-11.

Mukhin NA. Goodpasture syndrome. Klin farmakol ter. 2012;21(5):39-44.

Ovsjannikov DJu, Volkov MJu, Gitinov ShA, et al. Goodpasture's syndrome in childhood: literature review and clinical observation. Trudnyj pacient. 2015;13(8-9):45-48.

Arce-Salinas CA, Rodrıguez-Garcıa F, Gоmez-Vargas JI. Long-term efficacy of anti-CD20 antibodies in refractory lupus nephritis. Rheumatol Int. 2012 May;32(5):1245-9. doi: 10.1007/s00296-010-1755-0. 

Arzoo K, Sadeghi S, Liebman HA. Treatment of refractory antibody mediated autoimmune disorders with an anti-CD20 monoclonal antibody (rituximab). Ann Rheum Dis. 2002;61(10):922-924. PMID: 12228164. 

Chan AL, Louie S, Leslie KO, Juarez MM, Albertson TE. Cutting edge issues in Goodpasture's disease. Clin Rev Allergy Immunol. 2011 Oct;41(2):151-62. doi: 10.1007/s12016-010-8222-2.

Dammacco F, Battaglia S, Gesualdo L, Racanelli V. Goodpasture's disease: a report of ten cases and a review of the literature. Autoimmun Rev. 2013 Sep;12(11):1101-8. doi: 10.1016/j.autrev.2013.06.014. 

Fernandes R, Freitas S, Cunha P, Alves G, Cotter J. Goodpasture’s syndrome with absence of circulating anti-glomerular basement membrane antibodies: a case report. J Med Case Rep. 2016 Jul 27;10:205. doi: 10.1186/s13256-016-0984-6.

Fervenza FC, Terreros D, Boutaud A, et al. Recurrent Goodpasture's disease due to a monoclonal IgA-kappa circulating antibody. Am J Kidney Dis. 1999;34(3):549-555. doi: 10.1053/AJKD03400549.

Goodpasture EW. Landmark publication from The American Journal of the Medical Sciences: The significance of certain pulmonary lesions in relation to the etiology of influenza. Am J Med Sci. 2009 Aug;338(2):148-51. doi: 10.1097/MAJ.0b013e31818fff94.

Greco A, Rizzo MI, De Virgiio A, et al. Goodpasture's syndrome: a clinical update. Autoimmun Rev. 2015 Mar;14(3):246-53. doi: 10.1016/j.autrev.2014.11.006.

Hellmark T, Segelmark M. Diagnosis and classification of Goodpasture's disease (anti-GBM). J Autoimmun. 2014 Feb-Mar;48-49:108-12. doi: 10.1016/j.jaut.2014.01.024.

Huart A, Josse AG, Chauveau D, et al. Outcomes of patients with Goodpasture syndrome: A nationwide cohort-based study from the French Society of Hemapheresis. J Autoimmun. 2016 Sep;73:24-9. doi: 10.1016/j.jaut.2016.05.015.

Jennette JC, Falk RJ, Bacon PA, et al. 2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013 Jan;65(1):1-11. doi: 10.1002/art.37715. 

Krakower CA, Greenspon SA. Localization of the nephrotoxic agent within the isolated renal glomerulus. AMA Arch Pathol. 1952;51:629-639.

Levy JB, Turner AN, Rees AJ, Pusey CD. Long-term outcome of anti-glomerular basement membrane antibody disease treated with plasma exchange and immunosuppression. Ann Intern Med. 2001 Jun 5;134(11):1033-42. PMID: 11388816.

Lu TY, Ng KP, Cambridge G, et al. A retrospective seven-year analysis of the use of B cell depletion therapy in systemic lupus erythematosus at University College London Hospital: the first fifty patients. Arthritis Rheum. 2009 Apr 15;61(4):482-7. doi: 10.1002/art.24341.

Merkel F, Pullig O, Marx M, Netzer KO, Weber M. Course and prognosis of anti-basement membrane antibody (anti-BM-Ab)-mediated disease: report of 35 cases. Nephrol Dial Transplant. 1994;9(4):372-376 . PMID: 8084449.

Narayanan M, Casimiro I, Pichler R. A unique way to treat Goodpasture's disease. BMJ Case Rep. 2014 Nov 24;2014. pii: bcr2014206220. doi: 10.1136/bcr-2014-206220.

Sauter M, Schmid H, Anders HJ, Heller F, Weiss M, Sitter T. Loss of a renal graft due to recurrence of anti-GBM disease despite rituximab therapy. Clin Transplant. 2009 Jan-Feb;23(1):132-6. doi: 10.1111/j.1399-0012.2008.00912.x.

Schless B, Yildirim S, Beha D, Keller F, Czock D. Rituximab in two cases of Goodpasture's syndrome. NDT Plus. 2009 Jun;2(3):225-7. doi: 10.1093/ndtplus/sfp020.

Shah MK, Hugghins SY. Characteristics and outcomes of patients with Goodpasture's syndrome. South Med J. 2002 Dec;95(12):1411-8. PMID: 12597309.

Shah Y, Mohiuddin A, Sluman C, et al. Rituximab in anti-glomerular basement membrane disease. QJM. 2012 Feb;105(2):195-7. doi: 10.1093/qjmed/hcr001.

Stone JH, Merkel PA, Spiera R, et al. Rituximab versus cyclophosphamide for ANCA-associated vasculitis. N Engl J Med. 2010 Jul 15;363(3):221-32. doi: 10.1056/NEJMoa0909905.

Syeda UA, Singer NG, Magrey M.  Anti-glomerular basement membrane antibody disease treated with rituximab: a case-based review. Semin Arthritis Rheum. 2013 Jun;42(6):567-72. doi: 10.1016/j.semarthrit.2012.10.007.

Tanna A, Tam FW, Pusey CD. B-cell-targeted therapy in adult Glomerulonephritis. Expert Opin Biol Ther. 2013 Dec;13(12):1691-706. doi: 10.1517/14712598.2013.851191. 

Touzot M, Poisson J, Faquer S, et al. Rituximab in anti-GBM disease: A retrospective study of 8 patients. J Autoimmun. 2015 Jun;60:74-9. doi: 10.1016/j.jaut.2015.04.003.

Wechsler E, Yang T, Jordan SC, Vo A, Nast CC. Anti-glomerular basement membrane disease in an HIV-infected patient. Nat Clin Pract Nephrol. 2008 Mar;4(3):167-71. doi: 10.1038/ncpneph0724. 




Copyright (c) 2018 KIDNEYS

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© "Publishing House "Zaslavsky", 1997-2018

 

   Seo анализ сайта