Cystoid Macular Edema: A Rare Adverse Reaction to Rituximab

Abstract

Membranous glomerulonephritis is the leading cause of nephrotic syndrome in non-diabetic Caucasian adults. For patients at risk of progressing to end-stage renal disease, immunosuppression, particularly rituximab, is the recommended treatment. While extremely rare, cases of cystoid macular edema associated with rituximab have been documented in the literature. In this report, we present the case of a 54-year-old male with membranous glomerulonephritis at a high risk of progressing to end-stage renal disease who experienced cystoid macular edema hours after receiving rituximab infusion. Following the discontinuation of the medication, the patient spontaneously recovered visual acuity without the need for any targeted therapy.

Keywords: adverse drug events; cystoid macular edema; membranous glomerulonephritis; nephrotic syndrome; rituximab.

Figure 1. Membranous glomerulonephrits. Glomerulus with thickened basement membranes (1A - PAS stain 400x). Membranous and granular staining for IgG4 (1B- IgG4 400x).

Figure 2. Optical coherence tomography scans of the left eye at the initial presentation (A) and three months after rituximab discontinuation (B).

Figure 3. Optical coherence tomography scans of the right eye at the initial presentation (A) and three months after rituximab discontinuation (B).