PMC7311762_01
Historical view of immunosuppressive treatment with a detail on rituximab administrations and subsequent relapses. PDN, prednisone; CPH, cyclophosphamide; CYA, cyclosporine A; MMF, mycophenolate mofetil; RTX, rituximab.
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Despite sensitive to steroid therapy, she soon developed prednisone dependence, and steroid sparing immunosuppressive drugs were administered (Figure 1). As expected, she experienced subsequent relapses, with the need for new rituximab administrations, approximately one per year (Figure 1).
(A) Potassium levels (mmol/L) over time and potassium central laboratory normal value (3.3 mmol/L, dotted line). ECG before (B) and after (C) rituximab administration on November 21 and November 22, 2019.
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Before starting the infusion, at 9am, a blood gas test was performed: her serum potassium level was 4.0 mmol/L (Figure 2):sodium, calcium, magnesium, glucose, pH and bicarbonate levels were normal. An ECG was obtained reporting hypokalemia signs: normal sinus rhythm, HR 120 bpm, diffuse repolarization abnormalities, and not measurable QTc interval (Figure 2). A second ECG obtained on November 22 showed complete reversion of ventricular abnormalities (Figure 2).