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A clinical case of the successful use of rituximab in a patient with a severe course of аnti-glomerular basement membrane (anti-GBM) disease (Goodpasture’ syndrome) is described. The patient was admitted to the clinic in extremely severe condition with the manifestations of florid respiratory and renal failure, which required constant respiratory support and hemodialysis. The diagnosis of anti-GBM disease was made on the grounds of isolated lung and kidney damage as a type of rapidly progressing glomerulonephritis and hemorrhagic alveolitis, high titers of antibodies to the glomerular basement membrane (two-fold increase), no increase in titers of other antibodies peculiar to systemic connective tissue diseases and systemic vasculitis. The patient underwent synchronous pulse therapy with sequential application of cascade plasma filtration, cyclophosphamide and methylprednisolone without significant improvement. The rationale for the use of rituximab was literature data, description of clinical cases, a more than double increase in the patient’s CD19+ level, a high level of anti-glomerular basement membrane, anemic syndrome and thrombocytopenia, as well as ineffectiveness of previous immunosuppressive therapy. Therapy with rituximab was performed at a dose of 1000 mg twice with a break of 14 days. A significant improvement in the clinical condition of the patient, a return to spontaneous breatheing, the absence of hemoptysis, dyspnoea at rest and on exertion, the normalization of platelet and hemoglobin levels, the radical improvement of CT lung picture were noted. A repeated blood test for glomerular basement membrane antibodies indicated their absence. Therapy with rituximab was performed in the first month after the diagnosis of anti-GBM disease, which saved the patient’s life and restored lung function.

A FAVORABLE OUTCOME OF HEMORRHAGIC ALVEOLITIS CAUSED BY ANTIBODIES TO GLOMERULAR BASEMENT MEMBRANE, IN THE TREATMENT WITH RITUXIMAB