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Case Reports in Medicine
Volume 2012, Article ID 680431, 4 pages
http://dx.doi.org/10.1155/2012/680431
Case Report

Rituximab-Induced Bronchiolitis Obliterans Organizing Pneumonia

1Department of Medicine, Fairview Hospital, Cleveland, OH 44111, USA
2Department of Pathology, Cleveland Clinic Cancer Center, Fairview Hospital, Cleveland, OH 44111, USA
3Moll Pavilion, Fairview Hospital, Cleveland, OH 44111, USA

Received 3 April 2012; Revised 10 May 2012; Accepted 16 May 2012

Academic Editor: Bruno Megarbane

Copyright © 2012 Ahmet B. Ergin 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

Rituximab-induced lung disease (R-ILD) is a rare entity that should be considered in patients treated with rituximab who present with dyspnea, fever, and cough, but no clear evidence of infection. A variety of pathologic findings have been described in this setting. Bronchiolitis obliterans organizing pneumonia (BOOP) is the most common clinicopathologic diagnosis, followed by interstitial pneumonitis, acute respiratory distress syndrome (ARDS), and hypersensitivity pneumonitis. Prompt diagnosis and treatment with corticosteroids are essential as discussed by Wagner et al. (2007). Here we present a case of an 82-year-old man who was treated with rituximab for recurrent marginal zone lymphoma. After the first infusion of rituximab, he reported fever, chills, and dyspnea. On computed tomography imaging, he was found to have bilateral patchy infiltrates, consistent with BOOP on biopsy. In our patient, BOOP was caused by single-agent rituximab, in the first week after the first infusion of rituximab. We reviewed the relevant literature to clarify the different presentations and characteristics of R-ILD and raise awareness of this relatively overlooked entity.