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Allergic reaction and weight gain: case report In a case series, a 22-year-old woman was described who developed weight gain during treatment with prednisolone, and allergic reaction during treatment with rituximab and ofatumumab for Isolated IgG4-related hypophysitis. The woman was admitted with worsening headaches, polyuria and polydipsia for 12 months. Her medical history was significant for migraines and asthma. But, she did not recieve any regular medications. However, she had a progestogen-only contraceptive implant in situ. On investigation, an enlarged and diffusely enhancing pituitary gland extending into the suprasellar cistern, with adjacent dural enhancement was noted. Thereafter, she was initiated on glucocorticoid therapy and desmopressin replacement. After that, a biopsy demonstrated lymphoplasmacytic infiltrate with focal granulomatous inflammation, which contained numerous IgG4-positive plasma cells. Subsequently, she was initiated on a tapering course of prednisolone starting at 30 mg/day. Consequently, the improvement of her headaches, polyuria and polydipsia were noted. After that, her diabetes insipidus complete resolved. However, following the reduction of prednisolone, her headache returned and therefore the dose was increased. Consequently, she gained a significant amount of weight. Hence, she was started on rituximab 1000mg infusion twice/ 2 weeks apart. After 4 months, her initial presentation, her symptoms completely resolved. After 12 months, her symptoms returned, and she received a further dose of rituximab, but she developed an allergic reaction and immediately the treatment was terminated. Despite not receiving the full dose, her headaches resolved and the pituitary enlargement almost fully normalised. Her B cells remained to deplete for 8 months. After 10 months, her symptoms recurred once again. She was therefore challenged with a different anti-CD20 monoclonal antibody ofatumumab infusion. However, once again, she developed an allergic reaction 20 minutes of the infusion, immediately the infusion was stopped. Despite the short infusion of ofatumumab, complete B cell depletion which lasted for 4 months. Thereafter, her symptoms significantly improved, and she remained in full remission. Boharoon H, et al. A Case Series of Patients with Isolated IgG4-related Hypophysitis Treated with Rituximab. Journal of the Endocrine Society 4: bvaa048, No. 6, 2020. 803515835 Available from: URL: http://doi.org/10.1210/jendso/bvaa048

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Reactions 21 Nov 2020 No. 1831