Cardiogenic Shock Secondary to Rituximab Administration: A Case Report

Rituximab is a synthetic antibody used in the treatment of B cell-mediated autoimmune diseases, including immune thrombotic thrombocytopenic purpura.Although generally well tolerated, it may be associated with adverse effects, ranging from infusion-related reactions to rare but severe delayed complications.We report the case of a 64-year-old woman with a history of systemic lupus erythematosus and immune thrombotic thrombocytopenia who developed cardiogenic shock following rituximab reintroduction.The patient presented five days after infusion with asthenia, dyspnea, and chest pain, preceded by arthralgia.Initial cardiac evaluation revealed severe left ventricular systolic dysfunction with diffuse hypokinesis.The patient required inotropic and vasopressor support for cardiogenic shock.Subsequently, she developed a macular rash and persistent polyarthralgia, consistent with a serum sickness-like reaction.This case suggests a diagnosis of rituximab-induced serum sickness associated with non-ischemic cardiomyopathy leading to cardiogenic shock.While cardiac adverse events related to rituximab are uncommon, they may include acute coronary syndromes, arrhythmias, and cardiomyopathy.Delayed presentations, although rare, should be recognized.