The gold standard therapy for HIV-associated MCD is yet to be established. Vinblastine, etoposide and doxorubicin plus corticosteroids have all been used previously. Etoposide has been shown to be effective with resolution of systemic symptoms during its administration. However it has not been associated with prolonged remission. Interruption of chemotherapy usually results in clinical recurrence and most patients remain chemotherapy-dependent for life. In addition its use can be associated with cytopaenias. The use of etoposide would have been considered as adjuvant therapy in our case had the MCD not responded to rituximab monotherapy. In contrast rituximab is well tolerated and has been shown to be effective in case reports and series [1] [2] [3] . The role of rituximab in therapy for critically ill patients is less well established. In previously published reports, those admitted to ICU did not survive. Recently, however, a successful outcome of rituximab, in conjunction with cyclophosphamide, adriamycin and prednisolone, in the ICU setting, has been described [7] .