Clinical and laboratory features
| Parameter (normal range) . | Patient 1 . | Patient 2 . | Patient 3 . | Patient 4 . |
|---|---|---|---|---|
| Age, y/sex/ethnicity | 46/F/Filipino* | 69/F/Filipino† | 50/F/Laotian | 60/F/Vietnamese |
| Treatment duration before rituximab, y | 5 | 7‡ | > 1 | 1 |
| Directed therapy prior to rituximab‡ | IFN-γ | IFN-γ | IFN-γ | Amikacin |
| Clarithromycin | Intravenous immunoglobulin | Clarithromycin | Azithromycin | |
| Ethambutol | Plasmapheresis | Ethambutol | Clarithromycin | |
| Isoniazid | Amikacin | Moxifloxacin | Ethambutol | |
| Linezolid | Amoxicillin/clavulanate | Isoniazid | ||
| Moxifloxacin | Azithromycin | Levofloxacin | ||
| Tigecycline | Ciprofloxacin | Moxifloxacin | ||
| Ertapenem | Pyrazinamide | |||
| Ethambutol | Rifampin | |||
| Isoniazid | ||||
| Linezolid | ||||
| Meropenem | ||||
| Pyrazinamide | ||||
| Rifampin | ||||
| Tigecycline | ||||
| Total no. of rituximab doses received | 15 over 3 y | 18 over 5 y | 11 over 1 y | 9 over 2 y |
| Follow-up after start of rituximab, y | 5 | 6 | 4 | 2 |
| Mycobacterial species | M abscessus | M abscessus | M avium | M intracellulare |
| M avium complex | ||||
| Sites of infection (culture proven) | Lymph nodes, blood, urine, pelvic abscess, skin | Lymph nodes, blood, bone | Lymph nodes, bone, muscle | Bone, muscle, skin |
| Clinical course after rituximab | Clearance of bacteremia; resolution and closure of draining lymph nodes and pelvic abscess | Clearance of bacteremia; resolution of vertebral osteomyelitis and cord compression; normalization of liver enzymes | Improved lytic and blastic bony disease; resolution of muscle abscess, resolution and closure of draining lymph nodes | Improved lytic and blastic bony disease; resolution of multiple draining sinuses (sternum, clavicle, scapula) |
| Weight gain, kg | ND | ND | 15 | 17 |
| Culture | Bacteremia cleared | Bacteremia cleared | Sinus tracts closed, culture negative | Sinus tracts closed, culture negative |
| Imaging | Resolution of pelvic abscess | Healing of osteomyelitis after decompression and stabilization of spine | Resolution of pelvic abscesses; healing of osteomyelitis | Healing of osteomyelitis |
| Laboratory | ||||
| B lymphocytes; normal, 81-493/μL (time to full recovery after last rituximab, mo) | 165 (14) | 345 (12) | 260 (13) | 166 (7) |
| IgG; normal, 642-1730 mg/dL | Decreased from 2140 to 1280 | Decreased from to 3390§ to 1160 | Decreased from 2560 to 1050 | Decreased from 1940 to 1150 |
| ESR; normal, < 42.0 mm/h | Decreased from 81 to 59 | Decreased from 64 to 34 | Decreased from 67 to 51 | Decreased from > 140 to 111 |
| CRP; normal, < 0.8 mg/dL | Increased from 1.06 to 1.08 | ND | Decreased from 0.7 to 0.5 | Decreased from 8.8 to 4.6 |
| Anti–IFN-γ autoantibody levels | 80% decrease from baseline | 73.7% decrease from baseline | 65% decrease from baseline | 58% decrease from baseline |
| Comments | Relapsed twice and retreated with clinical improvement | Relapsed twice and retreated with clinical improvement | Relapsed twice and retreated with clinical improvement | 6 mo of rituximab before clinical improvement |
| Parameter (normal range) . | Patient 1 . | Patient 2 . | Patient 3 . | Patient 4 . |
|---|---|---|---|---|
| Age, y/sex/ethnicity | 46/F/Filipino* | 69/F/Filipino† | 50/F/Laotian | 60/F/Vietnamese |
| Treatment duration before rituximab, y | 5 | 7‡ | > 1 | 1 |
| Directed therapy prior to rituximab‡ | IFN-γ | IFN-γ | IFN-γ | Amikacin |
| Clarithromycin | Intravenous immunoglobulin | Clarithromycin | Azithromycin | |
| Ethambutol | Plasmapheresis | Ethambutol | Clarithromycin | |
| Isoniazid | Amikacin | Moxifloxacin | Ethambutol | |
| Linezolid | Amoxicillin/clavulanate | Isoniazid | ||
| Moxifloxacin | Azithromycin | Levofloxacin | ||
| Tigecycline | Ciprofloxacin | Moxifloxacin | ||
| Ertapenem | Pyrazinamide | |||
| Ethambutol | Rifampin | |||
| Isoniazid | ||||
| Linezolid | ||||
| Meropenem | ||||
| Pyrazinamide | ||||
| Rifampin | ||||
| Tigecycline | ||||
| Total no. of rituximab doses received | 15 over 3 y | 18 over 5 y | 11 over 1 y | 9 over 2 y |
| Follow-up after start of rituximab, y | 5 | 6 | 4 | 2 |
| Mycobacterial species | M abscessus | M abscessus | M avium | M intracellulare |
| M avium complex | ||||
| Sites of infection (culture proven) | Lymph nodes, blood, urine, pelvic abscess, skin | Lymph nodes, blood, bone | Lymph nodes, bone, muscle | Bone, muscle, skin |
| Clinical course after rituximab | Clearance of bacteremia; resolution and closure of draining lymph nodes and pelvic abscess | Clearance of bacteremia; resolution of vertebral osteomyelitis and cord compression; normalization of liver enzymes | Improved lytic and blastic bony disease; resolution of muscle abscess, resolution and closure of draining lymph nodes | Improved lytic and blastic bony disease; resolution of multiple draining sinuses (sternum, clavicle, scapula) |
| Weight gain, kg | ND | ND | 15 | 17 |
| Culture | Bacteremia cleared | Bacteremia cleared | Sinus tracts closed, culture negative | Sinus tracts closed, culture negative |
| Imaging | Resolution of pelvic abscess | Healing of osteomyelitis after decompression and stabilization of spine | Resolution of pelvic abscesses; healing of osteomyelitis | Healing of osteomyelitis |
| Laboratory | ||||
| B lymphocytes; normal, 81-493/μL (time to full recovery after last rituximab, mo) | 165 (14) | 345 (12) | 260 (13) | 166 (7) |
| IgG; normal, 642-1730 mg/dL | Decreased from 2140 to 1280 | Decreased from to 3390§ to 1160 | Decreased from 2560 to 1050 | Decreased from 1940 to 1150 |
| ESR; normal, < 42.0 mm/h | Decreased from 81 to 59 | Decreased from 64 to 34 | Decreased from 67 to 51 | Decreased from > 140 to 111 |
| CRP; normal, < 0.8 mg/dL | Increased from 1.06 to 1.08 | ND | Decreased from 0.7 to 0.5 | Decreased from 8.8 to 4.6 |
| Anti–IFN-γ autoantibody levels | 80% decrease from baseline | 73.7% decrease from baseline | 65% decrease from baseline | 58% decrease from baseline |
| Comments | Relapsed twice and retreated with clinical improvement | Relapsed twice and retreated with clinical improvement | Relapsed twice and retreated with clinical improvement | 6 mo of rituximab before clinical improvement |
ND indicates not done; ESR, erythrocyte sedimentation rate; and CRP, C-reactive protein.
Patient 2 in prior report.5
Patient 5 in prior report.5
Three or more antimycobacterials given at any time for all patients; IFN-γ treatment given before rituximab and continued while receiving rituximab for patients 2 and 3.
Value drawn 6 months before treatment.