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Case Reports: Findings that shed new light on the possible pathogenesis of a disease
Refractory fulminant colitis following ocrelizumab therapy requiring colectomy in a patient with multiple sclerosis
  1. Reuben Malloy1,2,
  2. Richard Fernandes1,2,
  3. Jakob Begun1,2 and
  4. Yoon-Kyo An1,2
  1. 1Gastroenterology Department, Mater Hospital Brisbane, Brisbane, Queensland, Australia
  2. 2Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
  1. Correspondence to Dr Reuben Malloy; reuben_malloy{at}hotmail.com

Abstract

A woman in her 40s was referred for acute and chronic postprandial abdominal cramps on a background of relapsing remitting multiple sclerosis on ocrelizumab therapy as well as coeliac disease on a gluten-free diet, with a family history of ulcerative colitis. Initial colonoscopy demonstrated mild patchy colitis. The patient was trialled on mesalazine, which was ceased due to intolerance. Subsequently, she continued on mercaptopurine monotherapy for management of mild symptoms. Despite this, her symptoms rapidly progressed, with endoscopic and histological evidence of severe rectal-sparing pancolonic inflammation, consistent with severe ocrelizumab-induced colitis. This was refractory to intravenous methylprednisolone and intravenous cyclosporine rescue therapy, requiring surgical management with a subtotal colectomy and subsequent ileorectal anastomosis, after which she remained in clinical, endoscopic and histological remission.

  • Inflammatory bowel disease
  • Gastrointestinal system
  • Gastrointestinal surgery
  • Multiple sclerosis
  • Neurology (drugs and medicines)

https://doi.org/10.1136/bcr-2022-252140

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    Footnotes

    • Contributors Supervised by Y-KA and JB. Patient was under the care of Y-KA. Report was written by RM, RF, JB and Y-KA.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.