利妥昔单抗致间质性肺疾病1例报告及文献复习

目的：探讨利妥昔单抗（RTX）致间质性肺疾病（ILD）（RTX-ILD）的发病机制、临床表现、诊断、鉴别诊断、治疗和预后。方法：1例19岁男性患者，确诊经典型霍奇金淋巴瘤2⁺年，1年前疾病复发，复发后行自体造血干细胞移植（HSCT），移植后2个月开始每月以375 mg·m^-2RTX维持化疗，期间纵隔复发行纵隔残留病灶放疗10次，第3次RTX维持治疗后第8天，患者出现活动后呼吸困难，伴发热、咳嗽、胸闷和乏力。胸部CT提示双肺多发斑片状磨玻璃影，血气分析提示低氧血症。先后给予抗细菌及抗真菌治疗，效果均不理想。后续反复多次行病原学检查均为阴性，支气管镜检查仍未见明显异常，考虑到RTX-ILD的可能，立即停用RTX并静脉给予40 mg·d^-1甲强龙治疗。结果：5 d后患者症状好转，后续激素改为口服并逐渐减量至停用。结论：RTX-ILD相对罕见，临床表现缺乏特异性，治疗以激素为主，对激素敏感者预后较好，激素不敏感者预后较差。

Rituximab-induced interstitial lung disease:A case report and literature review

Objective: To discuss the pathogenesis,clinical manifestations,diagnosis,differential diagnosis, treatment,and prognosis of the patient with rituximab (RTX)-induced interstitial lung disease (ILD) (RTX-ILD).Methods:A male patient aged 19 years old was confirmed as classical Hodgkin's lymphoma more than 2 years ago,and received autologous hemopoietic stem cell transplantation (HSCT)when the disease recurred 1 year ago.Two months after HSCT,the maintenance chemotherapy was given every month with 375 mg· m-2 RTX,but the mediastinal recurrence appeared during the period,then the mediastinal residual lesion radiotherapy was done for 10 times.However,8 d after the third RTX chemotherapy,the patient experienced post-exercising tachypnea,fever,cough,chest congestion,and limb weakness.The chest CT scanning results suggested ground gloss opacity on both lungs,and blood gas analysis suggested a hypoxemia.Neither antibacterial nor antifungal treatment worked well.Afterwards,the sequential etiological examination showed the negative results,and the bronchoscope examination showed the normal results as well.Considering about the possibility of RTX-ILD,RTX was stopped immediately and turned to intravenous infusion of methylprednisolone 40 mg per day.Results:Five d later,the symptoms of the patients were improved,and the follow-up methylprednisolone was changed to oral and gradually reduced to discontinuation.Conclusion:RTX-ILD is relatively rare,and its clinical manifestations lack specificity. Hormonotherapy is the main method in treatment of RTX-ILD. The patients sensitive to hormonotherapy have better prognosis than those insensitive to hormonotherapy.