Response to Rituximab in a Case of Lupus Associated Digital Ischemia
Figure 1
(a) Right hand with swan neck and Z deformity of the thumb (before treatment). (b) Radiograph; AP of bilateral hands suggesting Jaccoud radiological features. (c) Digital ulcers of the second to fourth digits of the right hand (2 weeks after initial treatment with cyclophosphamide). (d) Unresponsiveness to initial treatment demonstrated by a serious progression from ischemic lesions to digital gangrene lesions of the second to fourth digits of the right hand (one month after initial treatment regimen; cyclophosphamide, corticosteroids, and prostaglandins). (e) Response to treatment observed after first cycle of rituximab therapy (5 months following the start of RTX treatment). (f) Complete remission of digital gangrenous lesions after 2 cycles of rituximab therapy (10th month of the RTX treatment protocol (rituximab, glucocorticoid, aspirin, azathioprine, and hydroxychloroquine)).
