case_images: PMC10937462_01
case_images: Timeline of disease-modifying treatments (DMTs) and dexamethasone (CCS) administration (upper panel) and serum liver tests (lower panel) during the latest episode of DILI experienced by the patient. A mild elevation in serum transaminase [serum alanine aminotransferase (ALT), and serum aspartate aminotransferase (AST)] was observed shortly after the first administration of ocrelizumab 300 mg IV, followed by a severe elevation in transaminase, gamma-glutamyl transpeptidase (GGT) and serum alkaline phosphatase (ALP) detected two weeks after the second dose. The levels of liver enzymes returned below the upper limit of normal (ULN) within two months, without the administration of any corticosteroid treatment. No further elevations were observed during the follow-up, including after ofatumumab start.
case_images: fneur-15-1363493-g001.jpg
case_images: PMC10937462_01_fneur-15-1363493-g001.jpg
case_images: fig1
case_images: Six days after the first IV infusion of ocrelizumab 300 mg, a mild elevation in AST (within twofold ULN) and ALT (within threefold ULN) was observed, while ALP, GGT and bilirubin were all within normal ranges (Figure 1). ALT 1198 U/L, ALP 236 U/L, GGT 224 U/L, bilirubin 4.5 mg/dL with 2.8 mg/dL conjugated; Figure 1). Anti-mitochondrial, anti-nuclear and anti-smooth muscle autoantibodies were all negative, as well as cytomegalovirus (CMV) and Epstein-Barr virus (EBV) DNA, anti-toxoplasma antibodies, HBsAg, anti-HBV antibodies and HBV DNA, which had tested negative also before ocrelizumab start.