When the Treatment Becomes the Threat: A Case of Rituximab-Induced Organizing Pneumonia
- 1Internal Medicine, Coimbra Hospital and University Centre, Coimbra, PRT
Abstract
Rituximab (RTX) is a chimeric monoclonal antibody against CD20-expressing B lymphocytes, widely used in B-cell malignancies. Although generally well-tolerated, pulmonary toxicity is a rare but potentially fatal complication. A 71-year-old male with hepatic non-Hodgkin lymphoma (NHL) in remission, on maintenance RTX, presented with a one-month history of fever, asthenia, and progressive dyspnea. Initial management for suspected community-acquired pneumonia with levofloxacin failed. Despite temporary improvement on piperacillin/tazobactam, symptoms recurred after discharge, progressing to hypoxemic respiratory failure. Extensive workup, including bronchoalveolar lavage (BAL) and positron emission tomography-computed tomography (PET-CT), ruled out infection and lymphoma relapse. Following a multidisciplinary review, RTX-induced organizing pneumonia (OP) was suspected. Initiation of high-dose methylprednisolone (250 mg/day) led to rapid clinical and radiological resolution. RTX-induced OP requires a high index of suspicion, as its clinical-radiological presentation mimics infectious pneumonia. Early recognition and prompt initiation of corticosteroids are associated with rapid clinical and radiological recovery and may reduce the risk of progression to irreversible pulmonary fibrosis.
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BibTeX
@article{belchior2026when,
title = {{When the Treatment Becomes the Threat: A Case of Rituximab-Induced Organizing Pneumonia}},
author = {Bernardo Belchior and Tiago Jorge Costa and Ana Saraiva and Sofia Brasil and Joana Paixão},
journal = {Cureus},
year = {2026},
month = oct,
doi = {10.7759/cureus.117468},
url = {https://doi.org/10.7759/cureus.117468},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - When the Treatment Becomes the Threat: A Case of Rituximab-Induced Organizing Pneumonia
AU - Bernardo Belchior
AU - Tiago Jorge Costa
AU - Ana Saraiva
AU - Sofia Brasil
AU - Joana Paixão
PY - 2026
DA - 2026/10/05
JO - Cureus
DO - 10.7759/cureus.117468
UR - https://doi.org/10.7759/cureus.117468
AB - Rituximab (RTX) is a chimeric monoclonal antibody against CD20-expressing B lymphocytes, widely used in B-cell malignancies. Although generally well-tolerated, pulmonary toxicity is a rare but potentially fatal complication. A 71-year-old male with hepatic non-Hodgkin lymphoma (NHL) in remission, on maintenance RTX, presented with a one-month history of fever, asthenia, and progressive dyspnea. Initial management for suspected community-acquired pneumonia with levofloxacin failed. Despite temporary improvement on piperacillin/tazobactam, symptoms recurred after discharge, progressing to hypoxemic respiratory failure. Extensive workup, including bronchoalveolar lavage (BAL) and positron emission tomography-computed tomography (PET-CT), ruled out infection and lymphoma relapse. Following a multidisciplinary review, RTX-induced organizing pneumonia (OP) was suspected. Initiation of high-dose methylprednisolone (250 mg/day) led to rapid clinical and radiological resolution. RTX-induced OP requires a high index of suspicion, as its clinical-radiological presentation mimics infectious pneumonia. Early recognition and prompt initiation of corticosteroids are associated with rapid clinical and radiological recovery and may reduce the risk of progression to irreversible pulmonary fibrosis.
SN - 2168-8184
ER -