The sarcoid-like reaction is a rare autoinflammatory disease that can
affect lymph nodes or organs but does not meet the diagnostic criteria
for systemic sarcoidosis. Several drug classes have been associated with
the development of a systemic sarcoid-like reaction, which defines
drug-induced sarcoidosis-like reactions and can affect a single organ.
Anti-CD20 antibodies (rituximab) have rarely been reported as
responsible for this reaction and this adverse effect has mainly been
described during the treatment of Hodgkin’s lymphoma. We report a unique
case of a sarcoid-like reaction complicating rituximab following the
treatment of a mantle cell lymphoma and interesting only the kidney. The
60-year-old patient presented with severe acute renal failure six months
after the end of his r-CHOP protocol and the urgent renal biopsy
revealed acute interstitial nephritis rich in granulomas without caseous
necrosis. After ruling out other causes of granulomatous nephritis, a
sarcoid-like reaction was retained since infiltration was limited to the
kidney. The temporal relationship between rituximab administration and
the sarcoid-like reaction onset in our patient supported the diagnosis
of a rituximab-induced sarcoidosis-like reaction. Oral corticosteroid
treatment led to rapid and lasting improvement in renal function.
Clinicians should be warned of this adverse effect and regular and
prolonged monitoring of renal function should be recommended during the
follow-up of patients after the end of treatment with rituximab.