Case Report

Combination Immunosuppressive Therapy Including Rituximab for Epstein-Barr Virus-Associated Hemophagocytic Lymphohistiocytosis in Adult-Onset Still’s Disease

Figure 1

Clinical response in relation to treatment with rituximab, anakinra, and cyclosporine. (a) Fever curve and treatment overview. Body temperature was taken twice a day via an infrared ear thermometer. Rituximab was started on day 6 at a dose of 375 mg/m2 and repeated once a week indicated by an arrow until virus suppression was achieved after the third infusion. Anakinra was started on day 8 at a dose of 100 mg daily and cyclosporine on day 19 at a dose of 200 mg daily (blood level aiming at 100 μg/L). (b) Correlating laboratory parameters over time. Dotted lines indicate the respective upper reference ranges. CRP: C-reactive protein; EBV: Epstein-Barr virus; GGT: gamma-glutamyltransferase.