Chronic Peripheral Neuropathy Responsive to Rituximab

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Rev Neurol Dis. 2006 Spring;3(2):78-81.

Chronic Peripheral Neuropathy Responsive to Rituximab.

JJ.

Department of Neurology, The Washington University Medical

Center, Washington, DC.

A 73-year-old man was referred for evaluation of unsteady gait and

numbness of the feet. His symptoms had progressed over the previous 3

years from numbness and tingling in his left lateral thigh to a gait

imbalance severe enough to necessitate crutches for ambulation. After

a thorough neurological work-up, including an electromyogram that was

markedly abnormal, and extensive testing for anti-nerve antibodies, a

diagnosis of neuropathy, secondary to monoclonal IgM antibodies

against myelin-associated glycoprotein, was made. Aggressive

treatment was deemed necessary; however, none of the standard

options, including intravenous immunoglobulin, prednisone, and

cytotoxic drugs, seemed suitable given his underlying health and the

severity of his deficit. A course of rituximab 375 mg/m2 weekly for 4

weeks was recommended for the patient. Shortly after the treatment

was completed, he began to notice a slow and steady improvement.

Within 3 months his gait had improved to the point where he no longer

required crutches or a cane and he was able to return to work.