Central nervous system inflammatory demyelination after rituximab therapy for idiopathic thrombocytopenic purpura
Received 13 March 2009; received in revised form 10 September 2009; accepted 7 October 2009. published online 09 November 2009.
Abstract
A 53-year-old female developed unilateral shoulder girdle pain, entire body paresthesiae and imbalance starting 10days 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.
Department of Neurology and Neuroscience, Weill Medical College of Cornell University, New York, USA
Department of Neurology and Neuroscience, Weill Cornell Medical Center/New York Presbyterian Hospital, 525 East 68th Street, New York NY 10065-4897, USA. Tel.: +1 212 746 2334; fax: +1 212 746 8742.
ABSTRACT