利妥昔单抗注射液致间质性肺疾病合并呼吸衰竭案例分析

A case of interstitial lung disease complicated with respiratory failure related to rituximab injection

目的 探讨免疫性血小板减少症患者发生间质性肺疾病（ILD）与使用利妥昔单抗注射液的相关性，并分析利妥昔单抗注射液致ILD的疾病特点、发生机制及治疗措施。方法 对1例使用利妥昔单抗注射液治疗免疫性血小板减少症后发生ILD的病例进行分析，并结合相关文献分析探讨。结果 该患者为青年女性，既往使用利妥昔单抗注射液600 mg静脉滴注1次，维持小剂量糖皮质激素治疗2个月，发生ILD。入院后接受广谱抗感染、大剂量激素冲击治疗，后因呼吸衰竭死亡；该患者无其他ILD风险因素，ILD的发生很可能与利妥昔单抗注射液使用相关。结论 利妥昔单抗注射液致ILD罕见，起病隐匿，机制不明，临床表现多样，诊断困难，治疗措施有限，需引起临床高度重视。

Objective To investigate the association between interstitial lung disease（ILD） and the use of rituximab injection in patients with immune thrombocytopenia（ITP）; to analyze characteristics, pathogenesis and therapeutic measures of rituximab-induced ILD. Methods One case of ILD after treatment with rituximab injection for ITP was analyzed. Results The patient was a young women who was intravenously administered rituximab injection 600 mg once and had small dose of glucocorticoid therapy for 2 months before the occurrence of ILD. The patient had broad-spectrum antibacterial agents and high-dose corticosteroid therapy after admission at Sichuan Provincial People′s Hospital and finally died of respiratory failure. The patient had no other ILD risk factors; the occurrence of ILD might be associated with rituximab injection. Conclusion Rituximab-induced ILD is rare and insidious with diverse clinical manifestations.