A new case report published in Annals of Internal Medicine describes a novel approach for treating fibrosing mediastinitis using rituximab injections directly into mediastinal lymph nodes combined with pulmonary artery angioplasty. Fibrosing mediastinitis is a rare condition characterized by excessive fibrous tissue growth in the mediastinum, often causing airway and vascular compression. Traditional interventions, such as stenting or angioplasty, provide temporary relief but have high restenosis rates, and systemic rituximab has been associated with infectious complications.
Researchers from Beijing Chao-Yang Hospital detail the case of a 60-year-old woman with a decade-long history of exertional dyspnea and chest tightness after occupational exposure to iron dust. Imaging revealed pulmonary hypertension and right middle lobe atelectasis due to mediastinal compression. After biopsy confirmed fibrosing mediastinitis, the care team administered two courses of rituximab injections into hypermetabolic lymph nodes under endoscopic ultrasound guidance.
Two months after the second injection, CT scans showed resolution of atelectasis, PET-CT demonstrated reduced metabolic activity, and the patient’s 6-minute walk distance improved from 0 to 230 meters. Subsequently, balloon angioplasty of severely stenotic pulmonary arteries further improved hemodynamics, reducing mean pulmonary artery pressure and increasing walk distance. Lung function also improved significantly. The only adverse event was influenza, managed successfully. To the author’s knowledge, this is the first reported case of lymph node–targeted rituximab for fibrosing mediastinitis. The authors note that further studies are needed to confirm safety and efficacy of this novel approach.
Reference:
Eteri Machavariani, Denise Esserman, Kostyantyn Dumchev, et al. Integrating Methadone Services Into Primary Care in Ukraine: Two-Year Outcomes From a Randomized Trial. Ann Intern Med. [Epub 9 December 2025]. doi:10.7326/ANNALS-25-01764