PMC8348550_01
Computed Tomography Scan of the Chest (Patient 1). The scan shows mosaic attenuation and peripheral tree-in-bud opacities (arrow) in the right-lower lobe.
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A computed tomography (CT) scan of the chest revealed peripheral tree-in-bud opacities in bilateral upper- and right-middle lobes, which were associated with air trapping on expiratory imaging (Fig. 1).
Changes in Spirometry and Lung Volume (L) After Rituximab Infusion (Patient 1). The red dashed lines mark the times of the infusion. FEV1 indicates forced expiratory volume in 1 second; FVC, forced vital capacity; RV, residual volume; TLC, total lung capacity. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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Repeat PFT showed a mild obstructive defect without bronchodilator response and stable to slightly improved parameters overall (Fig. 2): forced vital capacity (FVC), 3.13-3.39 L (77%-84% of predicted value); FEV1, 1.92-2.24 L (60%-70% of predicted value); Dlco, 23.5-25.2 mL min-1 mm
Changes in Spirometry Values and Lung Volume Measurements (% Predicted) After Rituximab Infusion (Patient 1). The red dashed lines mark the times of the infusion. Dlco indicates diffusing capacity of the lungs for carbon monoxide; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; RV, residual volume; TLC, total lung capacity. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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Her representative PFT continued to show a persistent but stable obstructive ventilatory defect (Table 1, Fig. 3).
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Computed Tomography Scans of the Chest (Patient 2). The scans show mosaic attenuation with air trapping, scattered cystic air spaces (A, blue arrows), and ground-glass opacities (B, red arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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Chest CT showed mosaic attenuation bilaterally, ground-glass opacities, and scattered small, thin-walled cysts most consistent with lymphocytic interstitial pneumonia and constrictive bronchiolitis (Fig. 4A and B).
Changes in Spirometry and Lung Volumes (L) After Rituximab Infusions (Patient 2). The red dashed lines mark the timing of the infusions. FEV1 indicates forced expiratory volume in 1 second; FVC, forced vital capacity; RV, residual volume; TLC, total lung capacity. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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Hg-1 or 47%-65% of predicted value) (Fig. 5, Fig. 6). Her chronic symptoms, PFT, and chest imaging remained stable for approximately 2 years after rituximab therapy.
Changes in Spirometry Values and Lung Volume Measurements (% Predicted) After Rituximab Infusions (Patient 2). The red dashed lines mark the timing of the infusions. Dlco indicates diffusing capacity of the lungs for carbon monoxide; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; RV, residual volume; TLC, total lung capacity. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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These changes are summarized in Table 2 and Fig. 6.