Rituximab-induced Acute Eosinophilic Pneumonia with Diffuse Alveolar Damage: A Case Report

We describe a case of relapsed mantle cell lymphoma receiving four doses of rituximab (375 mg/m2/week) as part of salvage chemotherapy. Acute respiratory distress with hypoxemic respiratory failure requiring ventilatory support was developed 6 weeks after the last dose of rituximab. The findings of microbiological studies did not identify any infectious agents. Bronchoalveolar larvage fluid showed eosinophilia which fulfilled the diagnostic criteria of acute eosinophilic pneumonia. The result of the open lung biopsy showed acute diffuse alveolar damage with interstitial edema, type II pneumocyte hyperplasia and hyaline membrane. Our patient exhibited a new pattern of rituximab-induced lung injury with an excellent and complete response to steroid therapy.