Tocilizumab

Immune complex glomerulonephritis: case report

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    An event is serious (based on the ICH definition) when the patient outcome is:

    • * death

    • * life-threatening

    • * hospitalisation

    • * disability

    • * congenital anomaly

    • * other medically important event

    “ ”

    A 70-year-old man developed immune complex glomerulonephritis (IC-GN) during treatment with tocilizumab for rheumatoid arthritis (RA).

    The man, who had a history of RA, was hospitalised for acute nephritic syndrome. He had been receiving methotrexate and biologics for RA. Three years previously, he was transitioned from adalimumab to tocilizumab [dosage and route not stated]. The RA had been in remission and the serum creatinine (Cr) level was noted to be 0.8 mg/dL. One month previously, after experiencing flu-like symptoms, he developed renal dysfunction, bilateral lower leg oedema, haematuria and proteinuria, which were suggestive of acute nephritic syndrome. On admission, laboratory investigations revealed renal dysfunction Cr 1.77mg/dL, eGFR 30.7 mL/min/1.73m2, urinary protein 0.75 g/gCr, hypocomplementemia (C3, 24 mg/dL; C4, 1 mg/dL; CH50, 0 IU/L) and urinary red blood cells 50-99 /high power field. Antinuclear antibody, parvoviral B19DNA, anti-streptolysin O and anti-dsDNA antibody were found to be negative, and cryoglobulin was weakly positive. Renal biopsy demonstrated endocapillary hypercellularity and mesangial cell proliferation along with partial crescent formation. Immunofluorescence analysis showed IgG, IgA, IgM, C3, and C1q deposition in the mesangium, and a diagnosis of tocilizumab-induced IC-GN was made.

    The man's tocilizumab and methotrexate were discontinued. He started receiving treatment with methylprednisolone and after 3 days, he started receiving prednisolone. Improvement in the renal function and urinary abnormalities was observed and increased serum complement levels were noted. After 5 months of treatment, his renal function was maintained with prednisolone.

    Reference

    1. Hibino S, et al. Tocilizumab-induced immune complex glomerulonephritis in a patient with rheumatoid arthritis. Journal of the American Society of Nephrology 30: 150-151, Jan 2019. Available from: URL: https://www.asn-online.org/education/kidneyweek/archives/ [abstract]

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    Tocilizumab. Reactions Weekly 1838, 499 (2021). https://doi.org/10.1007/s40278-021-89816-y

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