{
  "abstract": "We report the case of a male patient in his 30s with newly diagnosed multiple sclerosis who initially responded well to high-dose corticosteroids and was started on ofatumumab as disease-modifying therapy. Baseline laboratory investigations, viral screening and autoantibody testing were normal. Within days of the first injection, he developed jaundice, abdominal pain and gastrointestinal symptoms. Laboratory studies revealed severe hepatocellular injury with hyperbilirubinaemia, coagulopathy, elevated pancreatic enzymes and positive anti-smooth muscle antibodies, consistent with autoimmune hepatitis. Imaging demonstrated gallstone disease, which later progressed to acute calculous cholecystitis and severe necrotising pancreatitis. Ofatumumab was discontinued and corticosteroids with supportive therapy were administered. His liver function gradually normalised, and his gastrointestinal symptoms resolved. Neurological follow-up showed no residual deficits, with radiological stability. This case represents, to our knowledge, the first reported case of ofatumumab-associated autoimmune hepatitis complicated by necrotising pancreatitis, highlighting the importance of vigilance and multidisciplinary care when initiating B-cell-depleting therapy.",
  "authors": [
    {
      "affiliations": [
        "Neurology, Cairo University, Giza, Egypt",
        "General Medicine, Nizwa Hospital, Nizwa, Oman"
      ],
      "name": "Ahmed Dahshan"
    },
    {
      "affiliations": [
        "Neurology, Egypt Ministry of Health and Population, Mansoura, Egypt",
        "Neurology, Muhammad Dossary Hospital, Al Khobar, Saudi Arabia"
      ],
      "name": "Ossama ElSayed Abouelkhir"
    },
    {
      "affiliations": [
        "Internal Medicine, Muhammad Dossary Hospital, Al Khobar, Saudi Arabia"
      ],
      "name": "Mohammed Essam Badawy"
    },
    {
      "affiliations": [
        "Internal Medicine, Hamdard Institute of Medical Sciences and Research, New Delhi, Delhi, India",
        "Internal Medicine, Al Yousif Hospital, Al Khobar, Eastern Province, Saudi Arabia"
      ],
      "name": "Malik Dilaver Farooq"
    },
    {
      "affiliations": [
        "Internal Medicine, Al Yousif Hospital, Al Khobar, Eastern Province, Saudi Arabia",
        "Hepatology, Gastroenterology and Infectious Diseases, Kafr El-Sheikh University, Kafr El-Shaikh, Gharbia Governorate, Egypt"
      ],
      "name": "Mohamed H Emara"
    },
    {
      "affiliations": [
        "Radiology, Al Yousif Hospital, Al Khobar, Eastern Province, Saudi Arabia"
      ],
      "name": "Mohammed Ali Abd El Atty Atta"
    },
    {
      "affiliations": [
        "Radiology, Ain Shams University, Cairo, Cairo Governorate, Egypt",
        "Radiology, Muhammad Dossary Hospital, Al Khobar, Saudi Arabia"
      ],
      "name": "Rabab Mohamed Elsaeed Soliman"
    }
  ],
  "title": "Severe autoimmune hepatitis and necrotising pancreatitis following ofatumumab in a patient with multiple sclerosis",
  "uid": "82cfaca2-a3ed-59aa-b841-06fa0b20d44c"
}