| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
CASE REPORT |
1 Institutes of Endocrine Sciences, 2 Ophthalmology, 3 Radiology, 4 Internal Medicine, University of Milan, Fondazione Ospedale Policlinico IRCCS, Via Sforza, 35 20122 – Milan, Italy and 5 Pathology Unit, Department of Medicine, Surgery and Dentistry, Ospedale San Paolo, Milan, Italy
(Correspondence should be addressed to P Beck-Peccoz; Email: paolo.beckpeccoz{at}unimi.it)
Abstract
One patient with Graves’ hyperthyroidism and ophthalmopathy in its active phase and unresponsive to steroid, was treated with the anti-CD20 monoclonal antibody, rituximab (RTX), as part of an open study. The effect of RTX in the thyroid and the orbital tissues was studied. The ophthalmopathy responded to RTX therapy by ameliorating the eye signs with a decrease in the clinical activity score from 5 to 2 in 3 months, while the patient had peripheral B-cell depletion. Hyperthyroidism did not improve during the 6 months of B-cell depletion and serum TSH-receptor antibodies (TRAb) levels did not significantly change after RTX therapy. Therefore, the patient underwent total thyroidectomy and few B-cells were found in the thyroid tissue specimens. While the patient eye disease remained stable (clinical activity score = 2), we performed corrective orbital decompression and we found absence of lymphocytes in the orbital tissue specimens. We believe that RTX treatment in Graves’ disease may cause amelioration of ophthalmopathy by depleting total lymphocytes population in the orbit. The persistence of Graves’ hyperthyroidism suggests that a single cycle of RTX does not result in complete lymphocyte depletion in thyroid tissue and thus no decline in serum TRAb was observed.
This article has been cited by other articles:
|
|
 |
|
  D E Furst, E C Keystone, B Kirkham, R Fleischmann, P Mease, F C Breedveld, J S Smolen, J R Kalden, G R Burmester, J Braun, et al. Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2008 Ann Rheum Dis, December 1, 2008; 67(Suppl_3): iii2 - iii25. [Full Text] [PDF]
|
|
|
|
 |
|
 P. Rodien Rituximab in Graves' disease Eur. J. Endocrinol., November 1, 2008; 159(5): 515 - 516. [Full Text] [PDF]
|
|
|
|
 |
|
 M. S. Anderson Update in Endocrine Autoimmunity J. Clin. Endocrinol. Metab., October 1, 2008; 93(10): 3663 - 3670. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. El Fassi, O. Clemmensen, C. H. Nielsen, R. Z. Silkiss, and L. Hegedus Evidence of Intrathyroidal B-Lymphocyte Depletion after rituximab Therapy in a Patient with Graves' Disease J. Clin. Endocrinol. Metab., October 1, 2007; 92(10): 3762 - 3763. [Full Text] [PDF]
|
|
|
|
|
|
T. J. Smith B Cell Depletion in Graves' Disease: The Right Answer to the Wrong Question? J. Clin. Endocrinol. Metab., May 1, 2007; 92(5): 1620 - 1622. [Full Text] [PDF]
|
|
|
|
|
|
D. El Fassi, C. H. Nielsen, S. J. Bonnema, H. C. Hasselbalch, and L. Hegedus B Lymphocyte Depletion with the Monoclonal Antibody Rituximab in Graves' Disease: A Controlled Pilot Study J. Clin. Endocrinol. Metab., May 1, 2007; 92(5): 1769 - 1772. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Salvi, G. Vannucchi, I. Campi, N. Curro, D. Dazzi, S. Simonetta, P. Bonara, S. Rossi, C. Sina, C. Guastella, et al. Treatment of Graves' disease and associated ophthalmopathy with the anti-CD20 monoclonal antibody rituximab: an open study Eur. J. Endocrinol., January 1, 2007; 156(1): 33 - 40. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
