Adjuvant rituximab improves sensory ataxia in CIDP-related Sjögren syndrome

BMJ Case Rep. 2020 Aug 26;13(8):e234681. doi: 10.1136/bcr-2020-234681.

Abstract

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an autoimmune neuropathy characterised by insidious onset, progressive course, proximal and distal symmetrical weakness, and sensory impairment. It may affect patients of any age with varying degrees of clinical involvement and response rates to existing treatments. Sjögren syndrome (SS) is a systemic autoimmune disorder that primarily affects the exocrine glands causing a sicca syndrome. It may affect the peripheral nervous system, usually causing painful small fibre or pure sensory axonal neuropathy, ganglioneuronopathy or a predominantly sensory CIDP. We report the case of a 71-year-old man diagnosed with a debilitating and difficult-to-treat CIDP who, 5 years later, developed SS with pulmonary involvement. Due to lack of response to treatments other than periodic intravenous immunoglobulin (IVIg) every 12 days, we started adjuvant treatment with rituximab which increased the time interval between IVIg therapies by 50%, providing better quality of life for the patient.

Keywords: immunology; peripheral nerve disease; sjogren's syndrome.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Ataxia / drug therapy*
  • Ataxia / etiology*
  • Chemotherapy, Adjuvant
  • Humans
  • Immunologic Factors / therapeutic use*
  • Male
  • Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / complications*
  • Rituximab / therapeutic use*
  • Sjogren's Syndrome / complications*

Substances

  • Immunologic Factors
  • Rituximab