Rituximab, granuloma annulare, Raynauds

[Hutan]

My son has Raynaud's Phenomenon - where there are distinct colour changes in the skin of fingers and toes due to problems with peripheral blood flow. I think many people with ME have this problem.

I have had a granuloma annulare and my daughter has lately also developed a very large granuloma annulare. This is a (generally pretty innocuous) autoinflammatory condition of the skin causing a ring of raised red bumps. Wikipedia suggests it is a fairly rare condition so for both of us to get it is perhaps somewhat unusual.

Regular readers will know all three of us developed ME at the same time, 4 years ago although my daughter is now mostly recovered.

So, I was very interested to see that there are examples where both Raynaud's and granuloma annulare have resolved with treatment with rituximab. It would be good if ME patients being treated with rituximab and their doctors could watch out for these symptoms and document improvements or otherwise and correlations with ME improvements.

Perhaps the presence of these conditions may be indications of autoimmunity problems and therefore suggestive of a good result from Rituximab treatment of ME.

Severe Primary Raynaud's Disease Treated with Rituximab
Case Rep Rheumatol. 2016; 2016: 2053804.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5019931/

Here, we report a case of a 55-year-old female diagnosed with <Primary Raynaud's Phenomenon> 7 years ago. Treatment with first-line agents, including calcium channel blocker, aspirin, and phosphodiesterase inhibitor, did not control her symptoms, which progressed to digital ulceration and gangrene. There were no symptoms of underlying autoimmune disease or malignancy, and autoimmune, serology, and immunology test results were normal; a biopsy of her left little finger was negative for vasculitis. Development to critical digital ischemia necessitated treatment with intravenous iloprost and heparin infusion followed by angioplasty, which led to a partial improvement. Due to persistent symptoms, rituximab therapy was initiated and two cycles induced a complete resolution of symptoms.

Resolution of granuloma annulare following treatment with bendamustine and rituximab in a patient with follicular lymphoma: a serendipitous finding.
https://www.ncbi.nlm.nih.gov/pubmed/25370553
J Postgrad Med. 2014 Oct-Dec;60(4):406-8. doi: 10.4103/0022-3859.143975.

Granuloma annulare is a benign inflammatory dermatosis. ...We report in this paper a case of generalized granuloma annulare that resolved after the patient was treated with rituximab and bendamustine for stage IV follicular lymphoma.