CONCISE REPORT

Rituximab induces remission in refractory HCV associated cryoglobulinaemic vasculitis

P Lamprecht¹, C Lerin-Lozano¹, H Merz², R H Dennin³, A Gause¹, J Voswinkel¹, S O Peters⁴, O Gutzeit¹, A C Arlt⁵, W Solbach³, W L Gross¹

¹ Department of Rheumatology, University Hospital of Schleswig-Holstein, Campus Luebeck, and Rheumaklinik Bad Bramstedt, Ratzeburger Allee 160, 23538 Luebeck, Germany
² Institute of Pathology, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
³ Institute of Medical Microbiology and Hygiene, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
⁴ 1st Department of Medicine, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
⁵ Department of Neurology, Rheumaklinik Bad Bramstedt, Oskar-Alexander Str. 26, 24576 Bad Bramstedt, Germany

Correspondence to:
Correspondence to:
Dr P Lamprecht
; lamprecht{at}rheuma-zentrum.de

Objectives: To report the successful induction of remission with the monoclonal anti-CD20 antibody rituximab in a patient with hepatitis C virus (HCV) associated cryoglobulinaemic vasculitis and a non-Hodgkin’s lymphoma (NHL) resistant to previously advocated conventional treatments.

Case report: The patient was a 45 year old woman with HCV associated cryoglobulinaemic vasculitis, with purpura, arthralgia, constitutional symptoms, and a polyneuropathy. A malignant NHL was found as underlying lymphoproliferative disease. At this stage the disease was refractory to interferon 2b and ribavirin and to subsequent immunosuppressive treatment with cyclophosphamide. Six rituximab infusions targeting the CD20 antigen on cells of the B cell lineage induced remission of the vasculitis. Bone marrow biopsy disclosed absence of the NHL. Remission has subsequently been maintained and HCV eliminated with the new pegylated interferon 2b and ribavirin for nearly one year.

Conclusions: Transition of the underlying "benign" lymphoproliferative disease to a malignant lymphoma may result in difficult to treat HCV associated cryoglobulinaemic vasculitis. Rituximab offers a new possibility for inducing remission in refractory HCV associated cryoglobulinaemic vasculitis and the lymphoproliferative disorder. After remission, HCV may subsequently be eliminated with pegylated interferon 2b and ribavirin.

Keywords: vasculitis; cryoglobulin; hepatitis C virus; non-Hodgkin’s lymphoma; rituximab

Abbreviations: HCV, hepatitis C virus; IFN, interferon; NHL, non-Hodgkin’s lymphoma

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