Relapsed Wegener's granulomatosis after rituximab therapy--B cells are present in new pathological lesions despite persistent 'depletion' of peripheral blood

Nephrol Dial Transplant. 2008 Sep;23(9):3030-2. doi: 10.1093/ndt/gfn318. Epub 2008 Jun 27.


Wegener's granulomatosis (WG) is a chronic, relapsing, systemic autoimmune disease. Rituximab, a monoclonal antibody against human CD20, has shown promise as a novel treatment for WG. The monitoring of therapeutic B-cell 'depletion' by peripheral blood flow cytometry has been proposed to help monitor rituximab therapy. We report the case of a patient with known WG and granulomatous disease, successfully treated with rituximab, who relapsed whilst peripheral blood monitoring apparently indicated persistent B-cell depletion. Further investigations demonstrated CD20(+) B cells in tissue at sites of active disease. The implications for disease pathogenesis and clinical monitoring of disease are discussed.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antibodies, Monoclonal / therapeutic use*
  • Antibodies, Monoclonal, Murine-Derived
  • Antigens, CD20 / metabolism
  • B-Lymphocytes / metabolism
  • Granulomatosis with Polyangiitis / diagnostic imaging
  • Granulomatosis with Polyangiitis / drug therapy*
  • Granulomatosis with Polyangiitis / immunology
  • Granulomatosis with Polyangiitis / metabolism
  • Granulomatosis with Polyangiitis / pathology*
  • Humans
  • Immunohistochemistry
  • Immunologic Factors / therapeutic use*
  • Lung / diagnostic imaging
  • Lung / metabolism
  • Lymphocyte Depletion
  • Male
  • Recurrence
  • Rituximab
  • Tomography, X-Ray Computed


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Murine-Derived
  • Antigens, CD20
  • Immunologic Factors
  • Rituximab