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Diseases

Hepatic Tuberculosis Risk Highlighted in New Report on Rituximab Treatment

Strategic Insights

— 2 min read

A 81-year-old patient with C1q nephropathy with Minimal Change Disease (MCD) treated with rituximab has been diagnosed with hepatic tuberculosis, a rare but severe complication, according to a new report from investigators at Shaoxing Second Hospital in Zhejiang, People's Republic of China. The patient was admitted to the hospital with a 2-month history of bilateral lower extremity edema and was diagnosed with C1q nephropathy with MCD through renal biopsy. After treatment with 2 g rituximab, his proteinuria was relieved, but he later developed a 7-day fever, and a liver biopsy revealed granulomatous inflammation and patchy coagulative necrosis, leading to a diagnosis of hepatic tuberculosis. The patient received a 1-year anti-tuberculosis treatment, resulting in a significant reduction in the left lobe liver mass and complete disappearance of the mass on an 8-month follow-up CT scan.

Key Takeaways:

  • A 81-year-old patient with C1q nephropathy with Minimal Change Disease (MCD) developed hepatic tuberculosis after treatment with rituximab.
  • The diagnosis was confirmed through a liver biopsy, which showed characteristic granulomatous inflammation and patchy coagulative necrosis.
  • The patient received a 1-year anti-tuberculosis treatment, consisting of rifampicin, isoniazid, pyrazinamide, and ethambutol, resulting in a significant reduction in the liver mass and complete disappearance of the mass on follow-up CT scan.
  • Routine screening for latent tuberculosis is recommended in elderly patients with nephropathy and hypogammaglobulinemia before rituximab treatment.
  • This case highlights the risk of rare infections, such as tuberculosis, in elderly or immunocompromised patients treated with rituximab.

Statistics:

  • 81-year-old patient developed hepatic tuberculosis after treatment with rituximab.
  • 2-month history of bilateral lower extremity edema before admission to the hospital.
  • 7-day fever in October 2024, which led to diagnosis of hepatic tuberculosis.
  • 1-year anti-tuberculosis treatment with rifampicin 450 mg qd, isoniazid 300 mg qd, pyrazinamide 1,500 mg qd, and ethambutol 1,000 mg qd.
  • 3-day treatment before temperature returned to normal and abdominal pain was relieved.
  • 8-month follow-up CT scan showing complete disappearance of the liver mass.

Sources:

  • NewsRx. Studies Conducted at Shaoxing Second Hospital on Hepatic Tuberculosis Recently Published (Hepatic tuberculosis induced by rituximab treatment for C1q nephropathy with minimal change disease: a case report). TB & Outbreaks Week. September 16, 2025; p 7167.
  • Hepatic tuberculosis induced by rituximab treatment for C1q nephropathy with minimal change disease: a case report. Frontiers in Medicine, 2025,12. (Frontiers in Medicine - http://www.frontiersin.org/medicine)
  • Publisher: Frontiers Media S.A.

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