Rituximab therapy in a patient with steroid-refractory bird fancier's lung

BMJ Case Rep. 2020 Dec 22;13(12):e237232. doi: 10.1136/bcr-2020-237232.

Abstract

A 62-year-old woman presented with a 3-month history of shortness of breath on exertion and dry cough. On examination, she was noted to have fine end-inspiratory crepitations over the upper zone of the lungs. Pulmonary function tests (PFTs) showed a restrictive defect. Initial chest radiography revealed diffuse reticular interstitial shadowing while high-resolution CT scan of the thorax showed fibrotic changes. Avian precipitins were also highly positive for pigeons, parrots and budgerigars. Taking into account these results, the patient was diagnosed with hypersensitivity pneumonitis. Antigen avoidance, oral glucocorticoids and azathioprine achieved an initial improvement in PFTs and symptoms; however, the patient still deteriorated, requiring long-term oxygen therapy. While working the patient up for lung transplantation, rituximab was given to good effect (acting as a bridging therapy) as it achieved symptomatic relief and stabilisation of her PFTs.

Keywords: immunology; interstitial lung disease; radiology.

Publication types

  • Case Reports

MeSH terms

  • Animals
  • Bird Fancier's Lung / complications
  • Bird Fancier's Lung / diagnosis
  • Bird Fancier's Lung / drug therapy*
  • Bird Fancier's Lung / immunology
  • Cough / diagnosis
  • Cough / drug therapy*
  • Cough / immunology
  • Drug Resistance
  • Dyspnea / diagnosis
  • Dyspnea / drug therapy*
  • Dyspnea / immunology
  • Female
  • Glucocorticoids / pharmacology*
  • Glucocorticoids / therapeutic use
  • Humans
  • Lung / diagnostic imaging
  • Middle Aged
  • Oxygen / administration & dosage
  • Respiratory Function Tests
  • Rituximab / pharmacology
  • Rituximab / therapeutic use*
  • Tomography, X-Ray Computed
  • Treatment Outcome

Substances

  • Glucocorticoids
  • Rituximab
  • Oxygen