Ocrelizumab
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Ocrelizumab Muscle soreness and first report of dermatographism: case report
A 31-year-old woman developed dermatographism and muscle soreness following treatment with ocrelizumab for relapsing remitting multiple sclerosis. The woman, who had history of migraine and relapsing remitting multiple sclerosis presented due to linear urticarial plaques approximately 2 weeks following the first infusion of ocrelizumab. She had no history of allergic reactions or rashes. She tolerated the infusion of the first half dose of 300mg of ocrelizumab [route not stated], but later in the evening, she developed muscle soreness in both lower extremities. One week after the infusion, she developed a linear raised rash on her left shoulder associated with itching and burning. Her first episode of rash resolved after 2 hours without any intervention. Later, the rash reoccurred. At this time, she developed migratory numbness of her face involving bottom lip, chin and nose, which persisted for 3 days. She denied any infectious symptoms, fever or swelling/angioedema. Neurological examination was unchanged. Brain MRI was negative for abnormal enhancement or any new demyelinating lesions. Her laboratory work-up was also unremarkable. The woman was treated with diphenhydramine and prednisone taper with no noticeable effect on her rash. Thereafter, she had intermittent rash (popular or linear) with pruritus and burning in different areas of her body including chest, back, thighs, buttock and both arms. Each time, her rash resolved spontaneously within 2 hours. Initially, her rash occurred daily, but later waned in severity and frequency, and two months later, rash resolved completely. Three months after the infusion, evaluation by dermatology showed persistent dermatographism. Considering the temporal relation of rash onset and ocrelizumab and no other alternative aetiology of her symptoms, dermatographism was thought to be due to ocrelizumab. The woman’s symptoms did not reoccur during subsequent infusions. Raynowska J, et al. Dermatographism associated with ocrelizumab. Multiple Sclerosis and Related Disorders 46: 102505, Nov 2020. Available from: URL: http:// doi.org/10.1016/j.msard.2020.102505
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Editorial comment: A search of AdisBase, Medline, Embase and the WHO ADR database did not reveal any previous case reports of dermatographism associated with ocrelizumab.
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Reactions 21 Nov 2020 No. 1831
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