Severe rituximab‐induced pneumonitis in an immunocompromised child with acquired thrombotic thrombocytopenic purpura

Immunosuppressive strategies with rituximab are increasing in patients with acquired thrombotic thrombocytopenic purpura (TTP) that is refractory/relapsing after standard treatment.1–3 Rituximab can effectively kill ADAMTS13-specific B-cells and stop autoantibody production. Remission rates of 82–100% have been reported.1–3 Rituximab is usually well tolerated; most relevant adverse events are infusion-related; less frequently, immunological disorders may occur, with a consequent increased risk of opportunistic infections. Pulmonary adverse reactions (5.3% of patients), described approximately 2 weeks after the last rituximab dose, are usually mild, transient, and steroid-responsive. Less frequent pulmonary complications include interstitial pneumonitis bronchiolitis obliterans, hypersensitivity pneumonitis and diffuse alveolar hemorrhage.4