Supplementary Material for: First Reported Case of Ocrelizumab-Associated Leukocytoclastic Vasculitis in Primary Progressive Multiple Sclerosis: A Case Report

Background: Leukocytoclastic vasculitis (LCV) is a small vessel vasculitis primarily affecting the skin, and its association with specific drugs is not widely documented. This case study explores the occurrence of LCV following the initiation of Ocrelizumab, a monoclonal antibody used in the treatment of primary progressive multiple sclerosis (PPMS).
Case Presentation: A 49-year-old Iranian female with primary progressive multiple sclerosis (PPMS) developed lower limb edema and diffuse palpable purpura one week after starting Ocrelizumab therapy. Skin biopsy confirmed leukocytoclastic vasculitis (LCV), showing vessel wall destruction, neutrophil infiltration, and fibrinoid necrosis. Laboratory tests revealed elevated inflammatory markers, including [ESR 1hr: 52, CRP: 52.8], supporting the diagnosis. The patient’s symptoms improved after a course of intravenous methylprednisolone, and Ocrelizumab was resumed without recurrence of skin lesions. This case highlights the need for vigilance in detecting drug-related vasculitis in Ocrelizumab-treated patients.
Conclusion: This case is the first reported instance of LCV associated with Ocrelizumab in the treatment of multiple sclerosis. It underscores the need for awareness of potential drug-induced vasculitis in patients undergoing new or modified treatments and contributes to the growing understanding of adverse effects associated with Ocrelizumab.