Ocrelizumab-induced colitis and cytomegalovirus infection and their disadvantageous interaction with underlying multiple sclerosis

Abstract

Ocrelizumab is a humanized monoclonal antibody against the B-lymphocyte antigen CD20 and the only approved treatment option in primary progressive multiple sclerosis. Herpesvirus-related infections like cytomegalovirus (CMV) infections are common in patients receiving ocrelizumab, whereas gastrointestinal side effects with inflammatory bowel disease (IBD) like esophagitis or colitis are very rare. This case report describes the challenging clinical, endoscopic, and histologic features of an ocrelizumab-induced colitis overlapping with CMV infection and their disadvantageous interaction with the underlying multiple sclerosis.

Zusammenfassung

Ocrelizumab ist ein humanisierter monoklonaler Antikörper gegen das B-Lymphozyten-Antigen CD20 und die einzige zugelassene Behandlungsoption bei primär progredienter Multipler Sklerose. Herpesvirus-bedingte Infektionen wie eine Zytomegalievirus (CMV)-Infektion sind bei Patienten, die Ocrelizumab erhalten, häufig. Gastrointestinale Nebenwirkungen wie eine Ösophagitis oder eine Kolitis, welche einer chronisch-entzündlichen Darmerkrankung ähneln, sind dagegen sehr selten. Dieser Fallbericht beschreibt die herausfordernden klinischen, endoskopischen und histologischen Merkmale einer durch Ocrelizumab induzierten Kolitis, die sich mit einer CMV-Infektion überschneidet, sowie deren nachteilige Wechselwirkung mit der zugrunde liegenden Multiplen Sklerose.

Keywords

ocrelizumab toxicity - ocrelizumab tolerability - monoclonal CD20 antibody - inflammatory bowel disease - CMV-colitis - gastrointestinal side effects

Schlüsselwörter

Ocrelizumab Toxizität - Ocrelizumab Verträglichkeit - monoklonale CD20-Antikörper - chronisch-entzündliche Darmerkrankung - CMV Kolitis - gastrointestinale Nebenwirkungen

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