Rituximab-Associated Acute Ischemic Stroke in a Patient With Primary Angiitis of the Central Nervous System

During or after rituximab treatment, various serious side effects may occur. Cerebrovascular diseases are relatively limited among these side effects, and whether they are contingent on rituximab treatment is unclear. This case report highlights an unusual and severe event after rituximab treatment. Our patient was a 32-year-old female diagnosed with primary angiitis of the central nervous system (PACNS). Despite meticulous management with azathioprine, the patient's condition exhibited persistent ischemic activity, necessitating a therapeutic shift to rituximab. Regrettably, very soon after the initial rituximab infusion, a substantial acute ischemic stroke took place in the right cerebral hemisphere. We have interpreted that the significant stenosis in the right internal carotid artery, which had developed due to PACNS, may pose a risk for the development of acute ischemia in our patient after rituximab treatment. In conclusion, careful evaluation of rituximab treatment may be appropriate in patients with serious stenosis of intracranial major arteries.