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NDT Advance Access published online on June 27, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn318
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Relapsed Wegener's granulomatosis after rituximab therapy—B cells are present in new pathological lesions despite persistent ‘depletion’ of peripheral blood

Alastair J. Ferraro1,*, Stuart W. Smith1,*, Desley Neil2 and Caroline O.S. Savage1

1 Division of Infection and Immunity, Institute of Biomedical Research, Medical School, University of Birmingham, Edgbaston, Birmingham, B15 2TT 2 Department of Pathology, University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK

Correspondence and offprint requests to: * Caroline O. S. Savage, Division of Infection and Immunity, Institute of Biomedical Research, Medical School, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. Tel: +44 (0)121 414 6841; Fax: +44 (0)121 414 3599; E-mail: c.o.s.savage{at}bham.ac.uk



  Abstract

Wegener's granulomatosis (WG) is a chronic, relapsing, systemic autoimmune disease. Rituximab, a monoclonal antibody against human CD20, has shown promise as a novel treatment for WG. The monitoring of therapeutic B-cell ‘depletion’ by peripheral blood flow cytometry has been proposed to help monitor rituximab therapy.

We report the case of a patient with known WG and granulomatous disease, successfully treated with rituximab, who relapsed whilst peripheral blood monitoring apparently indicated persistent B-cell depletion. Further investigations demonstrated CD20+ B cells in tissue at sites of active disease. The implications for disease pathogenesis and clinical monitoring of disease are discussed.

Keywords: B-cell depletion; monitoring; rituximab; vasculitis

* Joint first authors.

Received for publication: 11. 5.08
Accepted in revised form: 16. 5.08


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