The sarcoid-like reaction is a rare autoinflammatory disease that can affect lymph nodes or organs but does not meet the diagnostic criteria for systemic
sarcoidosis. Several
drug classes have been associated with the development of a systemic sarcoid-like reaction, which defines
drug-induced
sarcoidosis-like reactions and can affect a single organ. Anti-CD20
antibodies (
rituximab) have rarely been reported as responsible for this reaction and this adverse effect has mainly been described during the treatment of
Hodgkin's lymphoma. We report a unique case of a sarcoid-like reaction complicating
rituximab following the treatment of a
mantle cell lymphoma and interesting only the kidney. The 60-year-old patient presented with severe
acute renal failure 6 months after the end of
his r-
CHOP protocol and the urgent renal biopsy revealed acute
interstitial nephritis rich in
granulomas without caseous
necrosis. After ruling out other causes of granulomatous
nephritis, a sarcoid-like reaction was retained since infiltration was limited to the kidney. The temporal relationship between
rituximab administration and the sarcoid-like reaction onset in our patient supported the diagnosis of a
rituximab-induced
sarcoidosis-like reaction. Oral
corticosteroid treatment led to rapid and lasting improvement in renal function. Clinicians should be warned of this adverse effect and regular and prolonged monitoring of renal function should be recommended during the follow-up of patients after the end of treatment with
rituximab.