Immune-globulin/rituximab: Lack of efficacy: case report.

A 54-year-old man with neuro-Sjogren's disease exhibited lack of efficacy during treatment with rituximab and immune-globulin. Despite receiving high doses of glucocorticoids, IVIG, and rituximab, his symptoms continued to progress, leading to respiratory failure and the need for intubation. Plasmapheresis was performed with improvement in respiratory weakness, but symptoms relapsed, requiring re-intubation. Treatment with cyclophosphamide was initiated for continued disease suppression, and a tracheostomy was performed in preparation for long-term ventilator wean. [Extracted from the article]