SUCCESSFUL TREATMENT OF GOODPASTURE’ SYNDROME WITH RITUXIMAB: DESCRIPTION OF A CLINICAL CASE

Golovach I.Yu.¹, Yaremenko O.B.², Stelmashchuk V.P.¹, Matijko V.N.¹, Chipko T.M. ¹, Korochev A.V.¹, Mikhalchenko E.M.¹, Myasnyi I.S.¹, Mikhalskaya L.V.¹

• ¹Feofaniya Clinical Hospital, Kyiv
• ²O.O. Bohomolets National Medical University, Kyiv

Summary. A clinical case of the successful use of rituximab in a patient with a severe course of Goodpasture’ syndrome is described. The patient was admitted to the clinic in extremely serious condition with the manifestations of florid respiratory and renal failure, which required constant respiratory support and hemodialysis. The diagnosis of Goodpasture’s syndrome was made on the grounds of isolated lung and kidney damage as a type of rapidly progressing glomerulonephritis and hemorrhagic alveolitis, high titres of antibodies to the glomerular basement membrane (twice), no increase in titres of other antibodies peculiar to systemic connective tissue diseases and systemic vasculitis. The patient underwent synchronous pulse therapy with sequential application of cascade plasma filtration, cyclophosphamide and methylprednisolone without significant improvement. The rationale for the use of rituximab in Goodpasture’s syndrome e was literature data, description of clinical cases, as well as a more than double increase in the patient’s CD19 + level, a high level of anti-glomerular basement membrane, anemic syndrome and thrombocytopenia, as well as ineffectiveness of previous immunosuppressive therapy. Therapy with rituximab was performed at a dose of 1000 mg twice with a break of 14 days. A significant improvement in the clinical condition of the patient, the ability to spontaneously breathe was restored, the absence of dyspnoea at rest and on exertion, the absence of hemoptysis, the normalization of platelet and hemoglobin indices, the improvement of CT lung picture were noted, and a repeated blood test for antibodies to the basal membranes of the glomerular apparatus indicated their absence. Therapy with rituximab was performed in the first month after the diagnosis of Goodpasture’s syndrome, which saved the patient’s life and restored lung function.