First Reported Case of Ocrelizumab-Associated Leukocytoclastic Vasculitis in Primary Progressive Multiple Sclerosis: A Case Report.

IF 0.4 Q4 CLINICAL NEUROLOGY

Case Reports in Neurology Pub Date : 2025-09-25 eCollection Date: 2025-01-01 DOI:10.1159/000548629

Mohammadali Nahayati, Mina Farahnezhad, Amir Khanmirzaei, Fatemeh Khosravani

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Abstract

Background: Leukocytoclastic vasculitis (LCV) is a small vessel vasculitis primarily affecting the skin, and its association with specific drugs is not widely documented. This case study explores the occurrence of LCV following the initiation of ocrelizumab, a monoclonal antibody used in the treatment of primary progressive multiple sclerosis (PPMS).

Case presentation: A 49-year-old Iranian female with PPMS developed lower limb edema and diffuse palpable purpura 1 week after starting ocrelizumab therapy. Skin biopsy confirmed LCV, showing vessel wall destruction, neutrophil infiltration, and fibrinoid necrosis. Laboratory tests revealed elevated inflammatory markers, including ESR 1 h: 52 and CRP: 52.8, supporting the diagnosis. The patient's symptoms improved after a course of intravenous methylprednisolone, and ocrelizumab was resumed without recurrence of skin lesions. This case highlights the need for vigilance in detecting drug-related vasculitis in ocrelizumab-treated patients.

Conclusion: This case is the first reported instance of LCV associated with ocrelizumab in the treatment of multiple sclerosis. It underscores the need for awareness of potential drug-induced vasculitis in patients undergoing new or modified treatments and contributes to the growing understanding of adverse effects associated with ocrelizumab.

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原发性进行性多发性硬化症中奥克雷珠单抗相关白细胞破裂性血管炎的首例报道：1例报告。

背景：白细胞破坏性血管炎（LCV）是一种主要影响皮肤的小血管性血管炎，其与特定药物的关系尚未得到广泛的报道。本病例研究探讨了用于治疗原发性进行性多发性硬化症（PPMS）的单克隆抗体ocrelizumab开始治疗后LCV的发生。病例介绍：一名49岁伊朗女性PPMS患者在开始ocrelizumab治疗1周后出现下肢水肿和弥漫性可触及紫癜。皮肤活检证实LCV，显示血管壁破坏，中性粒细胞浸润和纤维蛋白样坏死。实验室检查显示炎症标志物升高，包括ESR 1h: 52和CRP: 52.8，支持诊断。患者在静脉注射甲基强的松龙一个疗程后症状改善，并恢复使用奥克雷单抗，无皮肤病变复发。该病例强调了在检测奥克雷单抗治疗患者的药物相关性血管炎时保持警惕的必要性。结论：该病例是首个报道的LCV与ocrelizumab治疗多发性硬化症相关的病例。它强调了在接受新的或改良的治疗的患者中，有必要认识到潜在的药物性血管炎，并有助于对ocrelizumab相关不良反应的日益了解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Case Reports in Neurology Medicine-Neurology (clinical)

CiteScore

1.50

自引率

0.00%

发文量

审稿时长

14 weeks

期刊介绍： This new peer-reviewed online-only journal publishes original case reports covering the entire spectrum of neurology. Clinicians and researchers are given a tool to disseminate their personal experience to a wider public as well as to review interesting cases encountered by colleagues all over the world. To complement the contributions supplementary material is welcomed. The reports are searchable according to the key words supplied by the authors; it will thus be possible to search across the entire growing collection of case reports with universally used terms, further facilitating the retrieval of specific information. Following the open access principle, the entire contents can be retrieved at no charge, guaranteeing easy access to this valuable source of anecdotal information at all times.