Article in Japanese

Periorbital cellulitis in the context of severe hypogammaglobulinemia induced by rituximab

Sayaka Ono^1）, Ryo Nakatani^1）, Takahiro Fujii^1）, Aya Kato^1）, Yoko Shirai^1）, Kiyonobu Ishizuka^1）, Kenichiro Miura^1）

Rituximab （RTX） is known to cause hypogammaglobulinemia as a late side effect. This study reports the case of a school-aged child who developed periorbital cellulitis with severe hypogammaglobulinemia after multiple RTX administrations. The patient was an 11-year-old girl who had received RTX 11 times for frequently relapsing nephrotic syndrome. Although she had not experienced any episodes suggestive of increased susceptibility to infection, her immunoglobulin G （IgG） level had remained below 200 mg/dL for approximately two years prior to this admission. The last RTX administration was 20 days before admission. She presented with swelling and pain in the left upper eyelid, and contrast-enhanced computed tomography revealed left periorbital cellulitis. At the time of admission, her serum IgG was 77 mg/dL. Immunoglobulin was administered in addition to antibiotics, and the local findings improved. This case was thought to have developed periorbital cellulitis at an atypical age, due to persistent severe hypogammaglobulinemia induced by RTX. Immunoglobulin was administered to treat the severe hypogammaglobulinemia. In patients with persistent severe hypogammaglobulinemia after RTX administration, vigilance for atypical infections is warranted. Prompt medical consultation is advisable in the event of fever, and intravenous immunoglobulin therapy should be considered when necessary. （194/250words）

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1）Department of Pediatric Nephrology, Tokyo Women’s Medical University

Key words	periorbital cellulitis, rituximab, hypogammaglobulinemia
Received	March 23, 2025
Accepted	May 20, 2025

37 (3)：252─258,2025