Acute neurological deterioration after rituximab and R–CHOP therapy for anti–MAG neuropathy

Abstract

Over a course of 4 years, the 74–year–old patient presented here experienced progressive loss of balance and of sensory function in the limbs. He was diagnosed with lymphoplasmacytic lymphoma and neuropathy caused by the presence of anti–myelin–associated glycoprotein (anti–MAG) antibody. He received a one dose of R–CHOP and four treatments of rituximab given once weekly. Two weeks after the initiation of chemotherapy, he developed weakness in all four extremities and difficulty in walking. Rituximab was discontinued, and intravenous immunoglobulin and methylprednisolone pulse therapies were initiated. His weakness improved gradually, and he regained his ability to walk without assistance 7 months after the discontinuation of rituximab. Although the mechanism of deterioration in this patient remains unknown, caution should be exercised when using rituximab in cases of anti–MAG neuropathy.