Exacerbation of ulcerative colitis after rituximab salvage therapy

Inflamm Bowel Dis. 2007 Nov;13(11):1365-8. doi: 10.1002/ibd.20215.


Background: B-cells are considered to play a pathogenic role in human ulcerative colitis (UC) by producing autoantibodies that cause epithelial cell damage. Here we report on a patient with intractable UC who suffered from a severe exacerbation of UC after salvage therapy with rituximab, a B-cell-depleting anti-CD20-antibody.

Methods: A 58-year-old patient with active long-standing UC and unresponsiveness or adverse events to mesalamine, corticosteroids, azathioprine, methotrexate, infliximab, leukapheresis, mycophenolate mofetil, and adalimumab received 375 mg/m(2) rituximab.

Results: A severe exacerbation of UC activity was noted upon therapy that required hospitalization. Subsequent studies showed a complete depletion of CD20-positive mucosal B-cells associated with a suppression of local IL-10 production.

Conclusions: In contrast to rheumatoid arthritis patients, rituximab had deleterious effects in our UC patient by blocking IL-10 producing B-cells. Our data suggest an important anti- rather than proinflammatory role of B-cells in UC.

Publication types

  • Case Reports

MeSH terms

  • Antibodies, Monoclonal / adverse effects*
  • Antibodies, Monoclonal, Murine-Derived
  • B-Lymphocytes / drug effects
  • Colitis, Ulcerative / chemically induced*
  • Colitis, Ulcerative / pathology
  • Humans
  • Interleukin-10 / deficiency
  • Middle Aged
  • Rituximab
  • Salvage Therapy / adverse effects


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Murine-Derived
  • Interleukin-10
  • Rituximab