Clinical Case Report: A 65-Year-Old Presenting with Disseminated Intravascular Coagulation as a Rituximab Infusional Reaction

Introduction

Rituximab is a monoclonal antibody that targets the CD20 antigen on B cells and subsequently recruits immune effector functions to mediate their lysis.[1] It is approved in the European Union for the treatment of non-Hodgkin lymphoma, chronic lymphocytic leukemia, autoimmune diseases,[1] and it is also used in multiple off-label conditions. Although not considered myelosuppressive, hematological alterations are present in a few patients; ≥grade 3 neutropenia, anemia, and thrombocytopenia were only observed in 4.2, 1.1, and 1.7% of the patients, respectively.[1]

A pharmacovigilance study using the World Health Organization's database (Vigibase) showed that, although many widely used medicines may be associated with disseminated intravascular coagulation (DIC), the most frequently reported as potential causal agents were heparin, methotrexate, paracetamol, vincristine, and cytarabine.[2] Coagulation disorders after rituximab administration are considered uncommon.[1] Nevertheless, a few reports of DIC-like reactions after rituximab and obinutuzumab infusion have been published.[3] [4] [5] [6] [7] However, the rechallenge with anti-CD20 agents following DIC-like episodes has rarely been studied.

This article was prepared following the CARE Guidelines,[8] and it was reviewed by the local Ethics Committee (Hospital Universitario Puerta de Hierro Majadahonda), which determined that formal approval was not required in accordance with local regulations.

Publikationsverlauf

Eingereicht: 27. August 2025

Angenommen: 15. Oktober 2025

Artikel online veröffentlicht:
10. November 2025

• References

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