Rituximab has considerably modified thetherapeutic strategy for B-cell lymphoproliferative malignancies, most notably non-Hodgkin’s lymphoma (NHL). Rituximab, alone or in combination with chemo-therapy, is being used to treat NHL with limited toxicity. We report two cases, one fatal, of necrotizing fasciitis following the use of rituximab in patients with NHL. No obvious predisposing factors were noted in either case. Practitioners need to beaware of this rare side effect and take prompt and aggressive action at the first onset of symptoms.
Maloney DG, Liles TM, Czerwinski DK, et al.Phase I clinical trial using escalating single-dose infusion of chimeric anti-CD20 monoclonal antibody (IDEC-C2B8) in patients with recurrent B-cell lymphoma. Blood1994; 84: 2457-2466.
2.
McLaughlin P, Grillo-Lopez AJ, Link BK, et al.Rituximab chimeric anti-CD20 monoclonal antibody therapy for relapsed indolent lymphoma: half of patients respond to a four-dose treatment program. J Clin Oncol1998; 16: 2825-2833.
3.
Maloney DG, Grillo-Lopez AJ, White CA, et al.IDEC C2B8 (Rituximab) anti-CD20 monoclonal antibody therapy in patients with relapsed low-grade non-Hodgkin’s lymphoma. Blood1997; 90: 2188-2195.
4.
Hainsworth JD, Burris HA III, Morrissey LH, et al.Rituximab monoclonal antibody as initial systemic therapy for patients with low-grade non-Hodgkin lymphoma. Blood2000; 95: 3052-3056.
5.
Colombat P, Salles G, Brousse N, et al.Rituximab (anti-CD20 monoclonal antibody) as first-line therapy of follicular lymphoma patients with low tumor burden: clinical and molecular evaluation. Blood2001; 97: 101-106.
6.
Coiffier B, Haioun C, Ketterer N, et al.Rituximab (anti-CD20 monoclonal antibody) for the treatment of patients with relapsing or refractory aggressive lymphoma: a multicenter phase II study. Blood1998; 92: 1927-1932.
7.
Foran JM, Rohatiner AZ, Cunningham D, et al.European phase II study of rituximab (chimeric anti-CD20 monoclonal antibody) for patients with newly diagnosed mantle-cell lymphoma and previously treated mantle-cell lymphoma, immunocytoma, and small B-cell lymphocytic lymphoma. J Clin Oncol2000; 18: 317-324.
8.
Anderson DR, Grillo-Lopez A, Varns C, et al.Targeted anti-cancer therapy using rituximab, a chimaeric anti-CD20 antibody (IDEC-C2B8) in the treatment of non-Hodgkin’s B-cell lymphoma. Biochem Soc Trans1997; 25: 705-708.
9.
Vose J, Link B, Grossbard M, et al.Phase II study of rituximab in combination with CHOP chemotherapy in patients with previously untreated intermediate or high-grade non-Hodgkin’s lymphoma (NHL). Ann Oncol1999; 10: 58a-58a.
10.
Coiffier B, Lepage E, Briere J, et al.CHOP chemo-therapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med2002; 346: 235-242.
11.
Gozal D, Ziser A, Shupak A, et al.Necrotizing fasciitis. Arch Surg1986; 121: 233-235.
12.
Stevens DL.Streptococcal toxic shock syndrome: spectrum of disease, pathogenesis and new concepts in treatment. Emerg Infect Dis1995; 1: 69-78.
13.
Chelsom J, Halstensen A, Haga T, Hoiby EA.Necrotising fasciitis due to group A streptococci in western Norway: incidence and clinical features. Lancet1994; 344: 1111-1115.
14.
Stevens DL, Tanner MH, Winship J, et al.Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A. N Engl J Med1989; 321: 1-7.
15.
Naranjo CA, Busto U, Sellers EM, et al.A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther1981; 30: 239-245.
