Rjeily Nicole Bou, Nourbakhsh Bardia, Mowry Ellen M
From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (NBR, BN, EMM).
Int J MS Care. 2023 Sep-Oct;25(5):196-198. doi: 10.7224/1537-2073.2022-080. Epub 2023 Sep 14.
Serum sickness (SS) is a rare hypersensitivity reaction that can occur with monoclonal antibodies, and only 1 case of SS has been reported with ocrelizumab. We describe 2 patients with multiple sclerosis (MS) who developed SS/SS-like reactions (SSLRs) following ocrelizumab infusions. A man, aged 45 years, and a woman, aged 59 years, both with primary progressive MS, developed generalized weakness and arthralgias following their ocrelizumab infusions. Brain and spinal cord MRIs revealed no new or enhancing demyelinating lesions in both cases. They both had elevated inflammatory markers and negative infectious workups. They were subsequently treated for presumed SS with a steroid taper (and with potent anti-inflammatories in the second case), and symptoms improved dramatically after a few days. These cases suggest that SS/SSLRs should be suspected in a patient with new-onset arthralgia following ocrelizumab infusion who has an otherwise negative workup and rapid response to steroids.
血清病（SS）是一种罕见的超敏反应，可发生于单克隆抗体治疗时，而使用奥瑞珠单抗仅报告过1例血清病。我们描述了2例多发性硬化症（MS）患者，他们在输注奥瑞珠单抗后发生了血清病/血清病样反应（SSLRs）。一名45岁男性和一名59岁女性，均患有原发性进行性MS，在输注奥瑞珠单抗后出现全身无力和关节痛。两例患者的脑和脊髓MRI均未发现新的或强化的脱髓鞘病变。他们的炎症标志物均升高，感染相关检查结果均为阴性。随后，他们均接受了类固醇逐渐减量治疗（第二例患者还使用了强效抗炎药），几天后症状显著改善。这些病例提示，对于输注奥瑞珠单抗后出现新发关节痛、其他检查结果均为阴性且对类固醇治疗反应迅速的患者，应怀疑血清病/血清病样反应。
