Rituximab-related late-onset neutropenia in a patient with severe rheumatoid arthritis

A 34-year-old white woman, with a 22-year history of refractory and destructive RA, had been treated with a long list of disease-modifying antirheumatic drugs (gold salts, thiopronine, d -penicillamine, sulfasalazine, azathioprine, ciclosporin, methotrexate (MTX) and etanercept). Rheumatoid factor was positive and antinuclear and anti-DNA antibodies were negative. Because of persistent active disease (28 joint count Disease Activity Score 5.86) despite treatment with MTX (25 mg/week), etanercept (50 mg/week) and prednisone (10 mg/day), rituximab (two 1 g infusions at a 2-week interval) was started, combined with MTX and steroids in December 2005.