Rituximab and Chest Infections

[Grumpyoldmare]

Not long after my first 2 Rituximab infusions I was diagnosed with a chest infection and given antibiotics. The GP booked me in for a chest X-ray and 3 or 4 weeks later that showed lingering infection so I had another week if antibiotics.

At the weekend I felt very short of breath and my pulse was racing but I didn't have a temperature or otherwise feel unwell. When I saw my GP on Monday he sent me straight to A and E. The chest X-ray showed a lot if infection in 1 lung, but I still had no temperature and my blood tests showed no inflaminflammatory markers. Apart from the breathlessness I didn't feel unwell as I usually do when fighting an infection. I am on another round of antibiotics.

Has anyone else experienced this whilst on Rituximab? Is it because my immune system is so suppressed it doesn't react to the infection? Do I need a longer course or specific type of antibiotics?

On the positive side the RA does seem to be improving!

[J1707-]

slightly different from you . I felt a little unwell no temperature but skin had a sheen of sweat . Then got a boil rang 111 as I knew how low our immune systems are . They thought could turn into sepsis so on antibiotics. Finished course then one week later boil back again no temperature etc so now on more antibiotics. Rituximab suppresses our immune system so we don’t present as others don’t get temperatures and will get more infections and often take longer to get better.

[Grumpyoldmare in reply to J1707-]

Thanks. Will have to be switched on and make sure the GP knows, they can be very reluctant to prescribe antibiotics

[J1707- in reply to Grumpyoldmare]

Yes it’s surprising how many don’t understand biologics

[ks1966]

Hello. I suggest you do a sputum culture. I’m surprised you haven’t dot one yet.

The test will show whether or not you’re taking the right antibiotics. As far as I know a recurring chest infection warrants one. Goody luck

[Grumpyoldmare in reply to ks1966]

Trouble is I am not actually coughing anything up!

[ks1966 in reply to Grumpyoldmare]

If it doesn’t make you dizzy try huffing and puffing breathing. Take a deep breath and purse your lips while exhaling. Try it a few times and then cough. Hopefully you will get some sputum movement in your lungs.

[ageddancer]

Hi

I too have a chest infection and not coughing anything up...I am using a private physio for two appointment to see if she can help me to shift the problem (using the tapping techniques that are given to people with cystic fibroses). I am now on now on a second course of antibiotics.

This means I have had to stop Methotrexate, and cannot have either the flu or latest Covid jabs, My problem started the day after I was sent for Huff N Puff baseline tests at the hospital as I am told I have some lung damage. I have written to the Respiratory Consultant telling him all this. I knew I needed antibiotics but surgery wouldnt prescribe them without my being seen by a Doctor AND as I was on holiday had to sign up at a local Docs who immediately prescribed antibiotics. It isnt easy getting what we need when we need it. I hope your problem gets sorted......wishing you all the best.

[Grumpyoldmare in reply to ageddancer]

Thanks. Physio sounds like a good idea

[wilbertjellyfish]

Last December I had a bad pneumonia which only improved when I got morphine, more recently I had a flare and ended up in hospital again I was getting antibiotics because my chest x-ray wasn't right. When I saw a rheumatologist they allowed id not had an infection it was all a flare so check that out. No chance it's related to the rituximab. Hopefully not.

[wilbertjellyfish]

Last December I had a bad pneumonia which only improved when I got morphine, more recently I had a flare and ended up in hospital again I was getting antibiotics because my chest x-ray wasn't right. When I saw a rheumatologist they allowed id not had an infection it was all a flare so check that out. No chance it's related to the rituximab. Hopefully not.

[Leics]

Slightly different with me, I was unfortunate enough to have my immune system knocked out by Rtx and it’s never recovered. I’m now under an immunologist who insists that at the first sign of an infection I’m to be prescribed two weeks of antibiotics. I take a low dose of penicillin everyday which does seem to keep some of the nasties away. However I would ask for a sputum test to ensure that you’re on the correct ones. I had an infection last year which was antibiotic resistant and it took 3 different courses of antibiotics to clear it. I didn’t have a temperature either but had a follow up chest X-ray after about 6 weeks. I suggest you do the same. I think if I remember correctly the patient ‘warning’ card you should have had when commencing treatment warns of zero temperature and suggests antibiotics if infection is suspected.

[Grumpyoldmare in reply to Leics]

Oh poor you. The side effects of some meds can be so unpredictable. I habe caught every snuffle going for years, being on methotrexate. Looks like Ritiximab is going to be even worse for that. At least my RA is settling, so nice not to be in constant pain. Got repeat chest X RAY booked.

[Leics in reply to Grumpyoldmare]

I’m so pleased Rtx seems to be working for you at least that’s something. It didn’t work for me. Maybe if you’ve had lots of sniffles etc over the last few years I would check that your immune system is still holding up. I know generally they usually check your immunoglobulins between infusions but I’d definitely ask the question how they are doing. I didn’t and have had to live for 10 years with the consequences. I know that most people on Rtx have no issues at all but for the sake of double checking I’d find out by asking the question.

[Hidden]

I have 4 chest infections a year since rituxan . Common I'm told.

[Hidden]

Hi, I have just been taken off rituxan because of recurrent chest infections . I am still breathless and full of nastiness despite being well and my joiny pain was much improved. It's no good walking well if you can't breathe I was told. Starting upadacitinib in August