Fatal Reactivation of Cytomegalovirus Infection after Use of Rituximab for a Post-Transplantation Lymphoproliferative Disorder

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Abstract
Rituximab is a chimeric monoclonal antibody directed against the CD20 antigen expressed on most B cells and is used to treat B-cell non-Hodgkin's lymphoma.1 Recently, rituximab has been used to treat post-transplantation lymphoproliferative disorders, which may occur after solid-organ and bone marrow transplantation; the prognosis associated with these disorders is usually poor, even if the doses of immunosuppressive drugs are reduced. Rituximab induces profound and durable B-cell depletion without a substantial decrease in serum immunoglobulin levels. Viral infection has rarely been reported after the use of this agent. Hepatitis B reactivation,1,2 visceral varicella–zoster infection,3 and pure red-cell aplasia due to chronic parvovirus B19 infection4 have occurred in patients treated with rituximab, but in all these cases, rituximab was combined with chemotherapy. We describe a fatal reactivation of cytomegalovirus infection after rituximab therapy in a patient with a post-transplantation lymphoproliferative disorder.