CEN Case Reports

, Volume 7, Issue 1, pp 69–72 | Cite as

Serum sickness with refractory nephrotic syndrome following treatment with rituximab

  • Ryo Maeda
  • Yukihiko Kawasaki
  • Shinichiro Ohara
  • Kazuhide Suyama
  • Mitsuaki Hosoya
Case Report


Rituximab (RTX) is effective for treating childhood refractory nephrotic syndrome (NS), such as steroid-dependent (SD), frequently relapsing (FR), and steroid-resistant (SR) NS. While RTX has been proven to be effective in treating SDNS, FRNS, and SRNS, it may cause serum sickness, a rare illness characterized by fever, rash, and arthralgia, 10–14 days after primary antigen exposure or within a few days after secondary antigen exposure, by producing human anti-chimeric antibodies (HACAs). A 17-year-old girl with refractory SDNS treated with RTX and oral cyclosporine A was admitted with fever and arthralgia 10 days after the fifth RTX dose was administered. After RTX was started when she was 14-years-old, SDNS remission was then achieved, and prednisolone was discontinued. Although antibiotics and non-steroidal anti-inflammatory agents were administered, fever and arthralgia continued. After various inspections and clinical course, we considered her as RTX-induced serum sickness (RISS). The patient had an elevated HACA level and was diagnosed with RISS. Fever and arthralgia disappeared 5 days after onset. To the best of our knowledge, this is the first reported case of RISS with NS. Fever, rash, and arthralgia after RTX administration can be the initial symptoms.


Steroid-dependent nephrotic syndrome Refractory nephrotic syndrome Rituximab Human anti-chimeric antibodies Serum sickness 


Compliance with ethical standards

Conflict of interest

All the authors have declared that no conflict of interest exists.

Human and animal rights statement

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Japanese Society of Nephrology 2018

Authors and Affiliations

  • Ryo Maeda
    • 1
  • Yukihiko Kawasaki
    • 1
  • Shinichiro Ohara
    • 1
  • Kazuhide Suyama
    • 1
  • Mitsuaki Hosoya
    • 1
  1. 1.Department of PediatricsFukushima Medical University School of MedicineFukushima CityJapan

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