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Rituximab Hypogammaglobulinaemia IgG — ESENeph MCQ

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ModerateRenal VasculitisRituximab Hypogammaglobulinaemia IgGESENeph

A 55-year-old man with ANCA vasculitis on Rituximab maintenance develops progressive hypogammaglobulinaemia (IgG 2.8 g/L) with recurrent sinopulmonary infections. What intervention should be considered?

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Correct answer: E — Consider immunoglobulin replacement therapy (IVIg or subcutaneous Ig) if IgG consistently <4 g/L with recurrent infections

Rituximab-induced hypogammaglobulinaemia occurs in 20-40% of patients after repeated courses. It is caused by sustained B-cell depletion preventing new immunoglobulin production. When IgG falls below 4 g/L (particularly <3 g/L) and the patient has recurrent infections, immunoglobulin replacement therapy should be considered. KDIGO 2024 AAV guideline practice point acknowledges this complication. The decision to continue Rituximab must weigh vasculitis relapse risk against infection risk. Some patients require concurrent Ig replacement and Rituximab.

Reference: KDIGO 2024 – AAV Guideline; Roberts et al 2015 – Rituximab Hypogammaglobulinaemia