Author(s)

Kamel El-Reshaid¹, Abdulmohsen Al-Bader², Sana S. Almutairi³, Sayed H. M. Mohamad⁴

¹Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.
²Department of Otolaryngeology, Farwania Hospital, Ministry of Health, Kuwait City, Kuwait.
³Department of Medicine, Respiratory Unit, Amiri Hospital, Ministry of Health, Kuwait City, Kuwait.
⁴Department of Radiology, Al Salam Hospital, Kuwait City, Kuwait.

Background: The available data on cryptogenic chronic hypersensitivity pneumonitis (ccHP) indicate an inherited predisposition to disease with triggering autoimmune phenomena. Hence, we evaluated prospectively the role of a new autoimmune regimen in treatment of its severe and progressive disease. Patients and Methods: A total of 9 patients were included in the study. They had criteria for ccHP viz. 1) clinical features of cryptogenic progressive restrictive lung disease, 2) high-resolution computed tomographic pulmonary abnormalities, and 3) bronchoalveolar lavage lymphocytosis (>30%). The regimen consisted of an initial induction phase of 3-month Solumedrol 1 g IV daily for 3 days followed by 1 month of Prednisone (P) 60 mg/day to tapered down to discontinuation by 3rd month. They also had received Mycophenolate mofetil (MMF) 1 g twice daily for 3 months. This stage was followed by a maintenance phase of yearly Rituximab infusions (1 g followed by 1 g 2 weeks later). Results: compared to their previous 6 months deterioration; all patients showed significant improvement in their forced vital volume, diffusion capacity for carbon monoxide, 6-minutes-walk after the induction phase (at 3 months) which improved further at 15 months with Rituximab therapy. Conclusion: After 3-month induction therapy with P and MMF; yearly R treatment is a safe, practical and effective long-term therapy for ccHP.

Hypersensitivity Pneumonitis, Mycophenolate Mofetil, Rituximab, Spirometry, HRCT, BAL

El-Reshaid, K. , Al-Bader, A. , Almutairi, S. and Mohamad, S. (2023) The Beneficial Effect of 3-Month-Induction Therapy with Corticosteroids and Mycophenolate Mofetil Followed by Maintenance Therapy with Yearly Rituximab Infusions as Sole Maintenance Therapy in Cryptogenic Chronic Hypersensitivity Pneumonitis. International Journal of Clinical Medicine, 14, 338-346. doi: 10.4236/ijcm.2023.148029.