Rituximab Therapy for Severe Cutaneous Leukocytoclastic Angiitis Refractory to Corticosteroids, Cellcept and Cyclophosphamide
A 51-year-old Kuwaiti man was referred to our renal unit for similar skin lesions and isolated hematuria which had developed over a few weeks. He received a 6-week course of oral corticosteroids (1 mg/kg/day) without improvement. He was subjected to the same systematic assessment in the first patient which had included routine tests, serology as well as skin and kidney biopsy and celiac and renal arteriography. Skin biopsy confirmed the diagnosis of CLV with negative immune deposits and kidney biopsy was normal. He was initially treated with pulse medrol and cyclophosphamide as the previous patient and responded. In a similar fashion, he relapsed 6 months after discontinuation of the 12-month course. His lesions regressed with cellcept 1 g twice daily. However, they flared once the dose was reduced to 500 mg twice daily. After 6 months of such therapy, he received rituximab as in the previous protocol. He responded well and up to 16 months post-therapy. In a similar fashion, his CD19 remained <0.5% for 8 months following retuximab treatment then normalized, yet he still enjoys a good clinical remission 28 months since the start of therapy.