{
  "abstract": "Background Pelvic symptoms can occur as a consequence of immunosuppressive therapy, particularly in patients with Multiple Sclerosis (MS). These conditions are underreported, often due to stigma and limited clinician screening. We describe two cases of severe vaginitis and pelvic inflammatory disease in ocrelizumab-treated MS patients, discussing their diagnostic and management challenges.Cases We report two very similar cases of young female patients with MS who have been on ocrelizumab for a number of years and presented with sepsis and large necrotic pelvic collections originating from the vagina that were inseparable from surrounding structures and complicated by vesical and colorectal fistulas. Neither patient had hypogammaglobulinemia. In both cases, Ureaplasma was cultured in both instances and treated as a disseminated Ureaplasma infection.Discussion Both cases suggest that ocrelizumab treatment can lead to severe vaginitis, even in the absence of hypogammaglobulinemia. The mechanism is unclear, it can be hypothesised to potentially be due to immune dysregulation affecting vaginal microbiome balance. Ureaplasma was identified as a pathogen in both cases, but its exact role remains unclear. While Ureaplasma is often considered a commensal organism in the vaginal microbiome, its presence in these immunocompromised patients is likely to be pathogenic. Management remains challenging, with some improvement seen after discontinuation of ocrelizumab and antibiotic therapy. 1–3 This report highlights the need for increased awareness and the development of management guidelines for MS patients on B-cell depleting therapies presenting with pelvic inflammatory and infective conditions.References Yockey L, et al. Inflammatory vaginitis in women on long-term rituximab treatment for autoimmune disorders. BMC Womens Health 2021;21(1):285. doi:10.1186/s12905–021-01423–0Levine L, et al. Inflammatory vaginitis in four B-cell suppressed women with Multiple Sclerosis. Mult Scler Relat Disord. 2024;82:105387. doi:10.1016/j.msard.2023.105387Fathi Z, Jørgensen RM, Therkildsen FS. Inflammatory vaginitis as a side effect of long-term rituximab treatment for multiple sclerosis. BMJ Case Rep. 2022;15(11):e250425. doi:10.1136/bcr-2022–250425",
  "authors": [
    {
      "affiliations": [
        "Alfred Health, Melbourne, VIC, Australia"
      ],
      "name": "Jessica Redmond"
    },
    {
      "affiliations": [
        "Alfred Health, Melbourne, VIC, Australia"
      ],
      "name": "Olga Skibina"
    }
  ],
  "title": "3601 Inflammatory and infective vaginitis in ocrelizumab-treated multiple sclerosis patients: two severe cases",
  "uid": "1694a236-3e33-56e2-aed5-c45fb1e5f637"
}