Abstract: TH-PO0824
Development of Crohn Disease After Obinutuzumab Administration
Session Information
- Glomerular Case Reports: Potpourri
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Nyabera, Akwe, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States
- Martínez-Belotto, Miguel, Hospital Universitario Marques de Valdecilla Servicio de Medicina Interna, Santander, Cantabria, Spain
- Navarro Torres, Mariela, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States
- Radhakrishnan, Jai, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States
Introduction
Obinutuzumab is a humanized glycoengineered type II anti-CD20 monoclonal antibody, developed to potentiate activity and overcome resistance to rituximab in hematological malignancies, with growing use in glomerular disease due to its overwhelming effectivity and favorable side effect profile. Though rare, severe toxicity can occur. We present a case of Crohn’s Disease after Obinutuzumab infusion.
Case Description
We present a 29 y/o woman with steroid-dependent minimal change disease diagnosed at age 20. In addition to steroid therapy, she had received immunosuppression with tacrolimus and rituximab for frequent relapses. Approximately a year after she completed therapy with tacrolimus, she had another flare with 12 g/g of proteinuria accompanied by severe hypoalbuminemia of 2.5g/dL. At this point she was initiated on Obinutuzumab (1g, 2 weeks apart). Two weeks after the second dose of Obinutuzumab, she went into complete remission with an undetectable UPCR. Four weeks after her 6- month maintenance dose of obinutuzumab, she developed oral ulcers, odynophagia, painful erythematous nodules over her lower extremities and progressive iron deficiency anemia. A skin biopsy revealed erythema nodosum and a colonoscopy showed ulcers in the sigmoid, descending and transverse colon. She was diagnosed with Crohn’s disease and treated with risankizumab with an excellent response.
Discussion
There is scarce data on inflammatory bowel disease as a complication of obinutuzumab administration. Two case reports describe diarrhea and colitis after obinutuzumab however, none fulfill Crohn’s disease criteria. This case represents a rare but severe adverse event. Due to their convenient dosing, tolerability and lower pill burden, the advent of anti-CD20 monoclonal antibodies has changed the treatment landscape in the glomerular disease space. Obinutuzumab is an effective drug for many glomerulopathies, but its effectiveness may come with a higher rate of adverse events of which we need to be cautious. It may lead to immune dysregulation, triggering inflammatory bowel disease in patients genetically or environmentally predisposed. To our knowledge, there are less than five cases of obinutuzumab- induced inflammatory bowel disease reported in the literature. This is the first reported case of obinutuzumab-induced Crohn’s disease after treatment of Minimal Change Disease.