Rituximab Treatment in a Patient with Active Graves' Orbitopathy and Psoriasis

Abstract

Management of Graves' orbitopathy remains an important therapeutic challenge. Current therapeutic modalities are unsatisfactory in about one third of patients. Rituximab is a monoclonal antibody against CD20 antigen that is expressed in mature and immature B cells. Early experience with rituximab suggests that it is a promising alternative therapy for Graves' orbitopathy. Here we report a case of a 49-year-old woman with Graves' orbitopathy and psoriasis. The patient received 2 infusions of 1 g rituximab 2 weeks apart. Although there was improvement in inflammatory signs of the disease, proptosis did not change after the treatment.

Keywords: Graves’ orbitopathy; Psoriasis; Rituximab.

Figure 1. A) Pretreatment photograph showing bilateral proptosis which is more pronounced on the right, lid retraction, lid hyperemia and edema, conjunctival hyperemia, and right caruncular edema; B) posttreatment photograph showing bilateral improvement in lid edema, hyperemia, lid retraction, and conjunctival hyperemia

Figure 2. Orbital magnetic resonance imaging showing A) pretreatment fusiform thickening of the extraocular muscles and B) posttreatment regression of the extraocular muscle thickening

Figure 3. A) Pretreatment photograph showing a light-colored psoriatic lesion on the top of the foot; B) posttreatment photograph showing regression of the psoriatic lesion