Late response to rituximab in a dialysis patient with severe lupus nephritis

Although recently completed controlled trials failed to demonstrate a significant effect of rituximab on the clinical outcome in non-renal and renal lupus,there is growing evidence from case reports and open-label trials that the use of this medication is successful in certain subgroups of patients including refractory cases and helps in reducing the dose of steroids. We present a 26-year-old female who failed to respond to a long-course treatment with prednisolone, cyclophosphamide, mycophenolate mofetil and azathioprine and who went on to develop end-stage renal disease requiring commencement of regular maintenance hemodialysis. Ten days before starting dialysis,she was given rituximab,and a second dose was given 17 days after starting dialysis. After 7 months on dialysis,the patient began to regain kidney function and is now off dialysis for 11 months. To the best of our knowledge,this is the first case report of a lupus patient on dialysis treated with rituximab in whom dialysis could be stopped and who remained off this therapy up till now,after an observation period of 1 year.