B35-46 Last Line, Significant Impact: Obinutuzumab in Refractory Granulomatosis With Polyangiitis (GPA)
Abstract
We present a case of granulomatosis with polyangiitis (GPA) refractory to rituximab and cyclophosphamide that responded clinically and biochemically to obinutuzumab, an anti-CD20 monoclonal antibody used to treat follicular lymphoma and lymphocytic leukemia.
A 55-year-old man with a history of biopsy-proven GPA with pulmonary, upper airway, and cutaneous involvement, presented to the hospital with 1-week of dyspnea on exertion (DOE) and subjective fever, chills, and night sweats. At the time of presentation he was receiving cyclophosphamide due to prior rituximab failure, with his most recent infusion approximately 2 weeks prior to hospitalization. Labs were notable for leukocytosis to 13.7 and elevated inflammatory markers (ESR 90 mm/h, CRP 290 mg/L). Serum proteinase 3 (PR3) was elevated to 168 AU/mL, the highest level recorded for this patient, although ANCA indirect immunofluorescence assay was negative. CT chest demonstrated new multifocal consolidations and mediastinal lymphadenopathy. He was started on broad spectrum antimicrobials. Sputum cultures later returned positive for few MRSA. Rheumatology recommended 2 doses of IVIG until additional infectious workup was obtained to determine safety of glucocorticoids. He underwent a bronchoscopy with bronchoalveolar lavage (BAL). Examination of the left mainstem bronchus revealed ulceration. BAL showed 2,000 red blood cells and 651 white blood cells (78% neutrophils). Cultures from BAL specimens were negative.…
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Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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