Finally, a 33-year-old man with stage IVB non-Hodgkin's lymphoma presented following a third cycle of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy. He had received a total of 2,190 mg of rituximab in three divided doses given at 21-day intervals, according to Dr. Charlotte M. Ford of the department of hematology, Newham University, London.
He had pyrexia, diarrhea, and a dry cough, along with clinical and radiologic evidence of left lower lobe pneumonia that persisted despite treatment with antibiotics and granulocyte colony-stimulating factor.
Adenovirus was isolated from bronchoalveolar lavage fluid, blood, and stool samples, and despite treatment with immunoglobulin and cidofovir plus intensive supportive care, he died on day 22.
Adenoviridae are lytic DNA viruses with varying degrees of pathogenicity, and infection is rarely fatal in otherwise healthy patients. “To our knowledge, this is the first case of fulminant adenovirus infection following rituximab therapy in doses similar to those used in the treatment of RA. Adenovirus infection should be considered in any patient presenting post rituximab with a febrile illness,” Dr. Ford wrote.