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Case Reports in Critical Care
Volume 2013 (2013), Article ID 123134, 4 pages
http://dx.doi.org/10.1155/2013/123134
Case Report

Rituximab—A Drug with Many Facets and Cures: A Treatment for Acute Refractory Hypoxemic Respiratory Failure Secondary to Severe Granulomatosis with Polyangiitis

Division of Pulmonary, Critical Care and Sleep Medicine, Saint Louis University 1402 South Grand Avenue, MC/SLUH/7 FDT, St. Louis, MO 63110-0250, USA

Received 27 December 2012; Accepted 15 January 2013

Academic Editors: C. Diez, M. Doganay, C. Lazzeri, G. Pichler, A. J. Reddy, and K. S. Waxman

Copyright © 2013 Braden Powers et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Granulomatosis with Polyangiitis (GPA) is a rare systemic anti neutrophil cytoplasmic antibody (ANCA-) associated granulomatous vasculitis of the small and medium sized blood vessels. Diffuse alveolar hemorrhage (DAH) is a rare life-threatening complication of GPA. In our patient, cyclophosphamide was held secondary to complications of acute kidney injury, hematuria, and concern for a possible hemorrhagic cystitis. However, during the workup for hematuria the patient acutely developed respiratory failure and was found to have DAH. The patient was initially supported with mechanical ventilation volume control mode, steroids, and plasma exchange. With no improvement of oxygenation, the mode of ventilation was changed to airway pressure release ventilation (APRV) and the patient was started on rituximab. The patient clinically improved over the next few days, was able to be extubated, and was transferred out of the intensive care unit.