关键词: 利妥昔单抗, 淋巴肿瘤, 间质性肺疾病, 感染, 造血干细胞移植

Abstract: Objective:To discuss the pathogenesis, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of the patient with rituximab (RTX)-induced interstitial lung disease(ILD)(RTX-ILD). Methods:A male patient aged 19 years old was confirmed as classical Hodgkin's lymphoma more than 2 years ago, and received autologous hemopoietic stem cell transplantation(HSCT) when the disease recurred 1 year ago. Two months after HSCT, the maintenance chemotherapy was given every month with 375 mg·m^-2 RTX, but the mediastinal recurrence appeared during the period, then the mediastinal residual lesion radiotherapy was done for 10 times. However, 8 d after the third RTX chemotherapy, the patient experienced post-exercising tachypnea, fever, cough, chest congestion, and limb weakness. The chest CT scanning results suggested ground gloss opacity on both lungs, and blood gas analysis suggested a hypoxemia. Neither antibacterial nor antifungal treatment worked well. Afterwards, the sequential etiological examination showed the negative results, and the bronchoscope examination showed the normal results as well. Considering about the possibility of RTX-ILD, RTX was stopped immediately and turned to intravenous infusion of methylprednisolone 40 mg per day. Results:Five d later, the symptoms of the patients were improved, and the follow-up methylprednisolone was changed to oral and gradually reduced to discontinuation. Conclusion:RTX-ILD is relatively rare,and its clinical manifestations lack specificity. Hormonotherapy is the main method in treatment of RTX-ILD. The patients sensitive to hormonotherapy have better prognosis than those insensitive to hormonotherapy.

Key words: rituximab, infection, lymphoma, interstitial lung disease, hemopoietic stem cell transplantation