Severe bronchospasm associated with rituximab for refractory Churg–Strauss syndrome
Department of Internal Medicine, French Vasculitis Study Group, Hôpital Cochin, Université Paris 5–René Descartes, Paris, France
Correspondence to:
Dr M-A Bouldouyre, Department of Internal Medicine, French Vasculitis Study Group, Hôpital Cochin, Université Paris 5–René Descartes, Paris, France; marie-anne.bouldouyre@cch.aphp.fr
Accepted 26 July 2008
| The first 150 words of the full text of this article appear below. |
Rituximab is now used to control antineutrophil cytoplasm antibody (ANCA)-associated vasculitides, eg, Wegener’s granulomatosis.1 2 In Churg–Strauss syndrome (CSS), a small-vessel systemic vasculitis with asthma and eosinophilia, 39% of patients have ANCA.3 4 Rituximab could be effective in ANCA-associated vasculitides, even if ANCA are not present at the time of prescription, because B lymphocytes also play a role as antigen-presenting cells and can modulate the immune response in another way than targeting antibody production. Therapy-refractory CSS5 was successfully treated with rituximab in three patients.6–8 We would like to draw attention to the potential risk of rituximab-associated bronchospasm, by reporting our experience with two CSS patients.
A 44-year-old woman had been treated for CSS for 2 years. Her initial symptoms included: paranasal sinusitis; persistent cough; weight loss; asthma; hypereosinophilia and bilateral pulmonary infiltrates. ANCA were negative. Despite high-dose corticosteroids, she was hospitalised in extremis three times for severe asthma. Azathioprine then methotrexate were
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