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CC BY 4.0 · Ibnosina Journal of Medicine and Biomedical Sciences
DOI: 10.1055/s-0046-1816539
Case Report

Unveiling the Uncommon: Infective Endocarditis Following Ocrelizumab Therapy in Relapsing-Remitting Multiple Sclerosis

Autor*innen

  • Hamdan AlAwadhi 

    1   Department of Internal Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

  • Mohamed Kamal Mansour

    1   Department of Internal Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

  • Hamza Obeid

    1   Department of Internal Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

  • Mohammad AlBakri

    1   Department of Internal Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

  • Suleiman Foudeh

    1   Department of Internal Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

Funding and Sponsorship None.
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Abstract

Ocrelizumab is an anti-CD20 monoclonal antibody approved for relapsing-remitting multiple sclerosis (RRMS) that induces B-cell depletion and may increase susceptibility to infection via hypogammaglobulinemia; however, serious bloodstream infections are uncommon, and infective endocarditis (IE) is rare. We describe a 20-year-old man with RRMS, hypertension, class II obesity, and type 2 diabetes who developed persistent fever 7 days after receiving a 300-mg ocrelizumab infusion, with blood cultures growing Staphylococcus aureus. Transesophageal echocardiography demonstrated a 4-mm mobile vegetation on the atrial aspect of the P2 scallop of the posterior mitral leaflet; chest computed tomography revealed bilateral peripheral nodules consistent with hematogenous infection, and cardiac magnetic resonance imaging suggested concomitant myocarditis. The patient completed 6 weeks of intravenous cefazolin with full clinical recovery, clearance of bacteremia, and echocardiographic resolution of the vegetation. To our knowledge, this represents the second published case report of S. aureus IE temporally associated with ocrelizumab therapy. Although causality cannot be established, anti-CD20-mediated B-cell depletion may be associated with increased infection risk in susceptible hosts, particularly those with cardiometabolic comorbidities and recent corticosteroid exposure. These findings underscore the importance of early evaluation for serious infection, including IE, in patients initiating ocrelizumab who present with persistent fever or bacteremia.

Keywords

multiple sclerosis - relapsing-remitting - ocrelizumab - infective endocarditis - Staphylococcus aureus - echocardiography - transesophageal - immunosuppression

Authors' Contributions

H.A. and S.F. contributed toward conceptualization. H.A., M.K.M., H.O., and M.A. investigated and curated the data. H.A. and S.F. contributed toward methodology. H.A. wrote the original draft. S.F. did the supervision. All authors wrote, reviewed, and edited the manuscript. They approved the final manuscript and agreed to be accountable for all aspects of the work.


Patient's Consent

The authors confirm that consent was obtained. All potentially identifying details were removed; CARE guidelines were followed.


Compliance with Ethical Principles

IRB approval was not required for a single-patient case report.




Publikationsverlauf

Artikel online veröffentlicht:
10. Februar 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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