Can Treatment Lead to Chronic Diarrhea in a Young Adult?

Rituximab may cause hypogammaglobulinemia in a subset of patients, especially if given in multiple cycles. Early clinical trial data suggested that hypogammaglobulinemia is transient, however subsequent reports have described hypogammaglobulinemia that is both persistent and clinically significant, necessitating immunoglobulins therapy in some cases [1-5]. Gastrointestinal disease is identified in approximately 10 to 20 percent of these patients and may be the presenting symptom in some [6]. Many of these disorders mimic classic forms of disease (in the absence of immunodeficiency) such as celiac sprue, inflammatory bowel disease (IBD), and pernicious anemia but differ in pathogenesis and are often unresponsive to conventional therapies. Gastroenterologists therefore must be able to diagnose and treat patients with immunodeficiency.