Rituximab induction therapy for de novo ANCA associated vasculitis in pregnancy: a case report
Abstract Background The diagnosis of antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) is rare in pregnancy but potentially life threatening. There are no randomized controlled trials to guide the management of AAV in pregnancy and fetal safety data remains limited. Rituximab ad...
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| Format: | Article |
| Language: | English |
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BMC
2018-06-01
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| Series: | BMC Nephrology |
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| Online Access: | http://link.springer.com/article/10.1186/s12882-018-0949-7 |
| _version_ | 1818822843614363648 |
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| author | Claire Harris Judith Marin Monica C. Beaulieu |
| author_facet | Claire Harris Judith Marin Monica C. Beaulieu |
| author_sort | Claire Harris |
| collection | DOAJ |
| description | Abstract Background The diagnosis of antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) is rare in pregnancy but potentially life threatening. There are no randomized controlled trials to guide the management of AAV in pregnancy and fetal safety data remains limited. Rituximab administration, a treatment for AAV, has been reported in pregnant women with reassuring fetal outcomes in the oncology and rheumatology literature; however, no published reports describe its use in AAV. Case presentation We present a case of de novo myeloperoxidase positive (MPO) AAV diagnosed at 22 weeks gestation. Clinical presentation included elevated serum creatinine at 177 μmol/L, hematuria and nephrotic range proteinuria along with high-titre MPO. Diagnosis was confirmed by renal biopsy. Patient was treated with methylprednisolone IV followed by oral prednisone 70 mg daily and Rituximab 650 mg IV weekly for four weeks followed by azathioprine maintenance therapy and prednisone taper. Delivery occurred at 29 weeks gestation via cesarean section for maternal neurologic symptoms concerning for preeclampsia. Maternal and fetal CD + 19 cells were depleted at time of delivery with associated fetal lymphopenia in the absence of infection or other complications related to Rituximab use. The patient experienced a reduction in proteinuria and inflammatory markers following Rituximab therapy; however, serum creatinine increased to 375 μmol/L by 11 weeks post-partum. Conclusion We report the first use, to our knowledge, of Rituximab with corticosteroids for induction therapy of AAV in pregnancy. |
| first_indexed | 2024-12-18T23:30:32Z |
| format | Article |
| id | doaj.art-442030af4a174ab78dbed1a887e0c743 |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-12-18T23:30:32Z |
| publishDate | 2018-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-442030af4a174ab78dbed1a887e0c7432022-12-21T20:47:41ZengBMCBMC Nephrology1471-23692018-06-011911410.1186/s12882-018-0949-7Rituximab induction therapy for de novo ANCA associated vasculitis in pregnancy: a case reportClaire Harris0Judith Marin1Monica C. Beaulieu2Division of Nephrology, University of British ColumbiaSt. Paul’s HospitalDivision of Nephrology, University of British ColumbiaAbstract Background The diagnosis of antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) is rare in pregnancy but potentially life threatening. There are no randomized controlled trials to guide the management of AAV in pregnancy and fetal safety data remains limited. Rituximab administration, a treatment for AAV, has been reported in pregnant women with reassuring fetal outcomes in the oncology and rheumatology literature; however, no published reports describe its use in AAV. Case presentation We present a case of de novo myeloperoxidase positive (MPO) AAV diagnosed at 22 weeks gestation. Clinical presentation included elevated serum creatinine at 177 μmol/L, hematuria and nephrotic range proteinuria along with high-titre MPO. Diagnosis was confirmed by renal biopsy. Patient was treated with methylprednisolone IV followed by oral prednisone 70 mg daily and Rituximab 650 mg IV weekly for four weeks followed by azathioprine maintenance therapy and prednisone taper. Delivery occurred at 29 weeks gestation via cesarean section for maternal neurologic symptoms concerning for preeclampsia. Maternal and fetal CD + 19 cells were depleted at time of delivery with associated fetal lymphopenia in the absence of infection or other complications related to Rituximab use. The patient experienced a reduction in proteinuria and inflammatory markers following Rituximab therapy; however, serum creatinine increased to 375 μmol/L by 11 weeks post-partum. Conclusion We report the first use, to our knowledge, of Rituximab with corticosteroids for induction therapy of AAV in pregnancy.http://link.springer.com/article/10.1186/s12882-018-0949-7Antineutrophil cytoplasmic antibody (ANCA)PregnancyCase reportRituximabMyeloperoxidase (MPO)Vasculitis |
| spellingShingle | Claire Harris Judith Marin Monica C. Beaulieu Rituximab induction therapy for de novo ANCA associated vasculitis in pregnancy: a case report BMC Nephrology Antineutrophil cytoplasmic antibody (ANCA) Pregnancy Case report Rituximab Myeloperoxidase (MPO) Vasculitis |
| title | Rituximab induction therapy for de novo ANCA associated vasculitis in pregnancy: a case report |
| title_full | Rituximab induction therapy for de novo ANCA associated vasculitis in pregnancy: a case report |
| title_fullStr | Rituximab induction therapy for de novo ANCA associated vasculitis in pregnancy: a case report |
| title_full_unstemmed | Rituximab induction therapy for de novo ANCA associated vasculitis in pregnancy: a case report |
| title_short | Rituximab induction therapy for de novo ANCA associated vasculitis in pregnancy: a case report |
| title_sort | rituximab induction therapy for de novo anca associated vasculitis in pregnancy a case report |
| topic | Antineutrophil cytoplasmic antibody (ANCA) Pregnancy Case report Rituximab Myeloperoxidase (MPO) Vasculitis |
| url | http://link.springer.com/article/10.1186/s12882-018-0949-7 |
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