Volume 288, Issue 1 , Pages 178-181, 15 January 2010
Central nervous system inflammatory demyelination after rituximab therapy for idiopathic thrombocytopenic purpura
Abstract
A 53-year-old female developed unilateral shoulder girdle pain, entire body paresthesiae and imbalance starting 10
days after completing a course of rituximab for chronic idiopathic thrombocytopenic purpura. Neuroimaging studies showed inflammatory demyelinating lesions of the cervical spinal cord and cerebellum.
Immunocytochemistry of spinal fluid lymphocytic pleocytosis showed an absolute B cell depletion and a polyclonal/inflammatory T cell response. Intravenous immunoglobulin infusions were associated with clinical and radiological improvements. Anti-CD20-therapy possibly resulted in an imbalance between B cell and T cell populations in the central nervous system, and may have triggered a predominantly cell-mediated immune attack against unidentified nervous system antigens.
Keywords: Idiopathic thrombocytopenic purpura, Rituximab, Anti-CD20 therapy, Central nervous system inflammatory demyelination
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PII: S0022-510X(09)00905-8
doi:10.1016/j.jns.2009.10.009
© 2009 Published by Elsevier Inc.
Volume 288, Issue 1 , Pages 178-181, 15 January 2010
