Acute onset of autoimmune hepatitis after initiation of B cell depletion therapy in multiple sclerosis

Background

Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease that may coexist in the multiple sclerosis population and remain undiagnosed. AIH has previously been reported following treatment with interferon beta, glatiramer acetate, natalizumab and high dose corticosteroids in people with multiple sclerosis (MS).

Case presentation

We present a rare case of autoimmune hepatitis onset after B cell depletion with ocrelizumab in a person with multiple sclerosis (MS).

Case report

Two weeks after the second dose of ocrelizumab, patient presented with jaundice and acute liver injury. Liver biopsy revealed pathological features of autoimmune hepatitis with negative workup for viral etiologies. A six month steroid taper and azathioprine resulted in normalization of liver function tests and clinical and radiological stability of multiple sclerosis and AIH at two years of follow-up.

Conclusions

Whether B cell depletion with ocrelizumab directly resulted in emergence of AIH is unclear. Regulatory B cells have been proposed to play a protective role in AIH pathogenesis and B cell depletion may provoke the emergence of AIH through loss of regulatory B cells.