{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T19:50:00Z","timestamp":1770148200411,"version":"3.49.0"},"reference-count":6,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,12,31]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2025-269312","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T15:30:25Z","timestamp":1768231825000},"page":"e269312","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Severe autoimmune hepatitis and necrotising pancreatitis following ofatumumab in a patient with multiple sclerosis"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0478-8486","authenticated-orcid":false,"given":"Ahmed","family":"Dahshan","sequence":"first","affiliation":[{"name":"Neurology, Cairo University, Giza, Egypt"},{"name":"General Medicine, Nizwa Hospital, Nizwa, Oman"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ossama ElSayed","family":"Abouelkhir","sequence":"additional","affiliation":[{"name":"Neurology, Egypt Ministry of Health and Population, Mansoura, Egypt"},{"name":"Neurology, Muhammad Dossary Hospital, Al Khobar, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed Essam","family":"Badawy","sequence":"additional","affiliation":[{"name":"Internal Medicine, Muhammad Dossary Hospital, Al Khobar, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Malik Dilaver","family":"Farooq","sequence":"additional","affiliation":[{"name":"Internal Medicine, Hamdard Institute of Medical Sciences and Research, New Delhi, Delhi, India"},{"name":"Internal Medicine, Al Yousif Hospital, Al Khobar, Eastern Province, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed H","family":"Emara","sequence":"additional","affiliation":[{"name":"Internal Medicine, Al Yousif Hospital, Al Khobar, Eastern Province, Saudi Arabia"},{"name":"Hepatology, Gastroenterology and Infectious Diseases, Kafr El-Sheikh University, Kafr El-Shaikh, Gharbia Governorate, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed Ali Abd El Atty","family":"Atta","sequence":"additional","affiliation":[{"name":"Radiology, Al Yousif Hospital, Al Khobar, Eastern Province, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rabab Mohamed Elsaeed","family":"Soliman","sequence":"additional","affiliation":[{"name":"Radiology, Ain Shams University, Cairo, Cairo Governorate, Egypt"},{"name":"Radiology, Muhammad Dossary Hospital, Al Khobar, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"2026011207301312000_19.1.e269312.1","doi-asserted-by":"crossref","first-page":"5087","DOI":"10.1007\/s10072-024-07614-5","article-title":"Concurrent management of multiple sclerosis and natalizumab-induced hepatitis with ofatumumab: a case report","volume":"45","author":"Haggiag","year":"2024","journal-title":"Neurol Sci"},{"key":"2026011207301312000_19.1.e269312.2","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2024.1363493","article-title":"Successful switch to ofatumumab after liver injury associated with ocrelizumab treatment in multiple sclerosis: a case report","volume":"15","author":"Mariottini","year":"2024","journal-title":"Front Neurol"},{"key":"2026011207301312000_19.1.e269312.3","unstructured":"National Institute of Diabetes and Digestive and Kidney Diseases (US) . LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. National Institute of Diabetes and Digestive and Kidney Diseases, 2012."},{"key":"2026011207301312000_19.1.e269312.4","doi-asserted-by":"crossref","first-page":"102381","DOI":"10.1016\/j.msard.2020.102381","article-title":"Acute pancreatitis after ocrelizumab treatment for relapsing remitting multiple sclerosis","volume":"45","author":"Adamec","year":"2020","journal-title":"Mult Scler Relat Disord"},{"key":"2026011207301312000_19.1.e269312.5","doi-asserted-by":"crossref","first-page":"100206","DOI":"10.1016\/j.nerep.2024.100206","article-title":"Acute onset of autoimmune hepatitis after initiation of B cell depletion therapy in multiple sclerosis","volume":"5","author":"Bahri","year":"2024","journal-title":"Neuroimmunology Reports"},{"key":"2026011207301312000_19.1.e269312.6","doi-asserted-by":"crossref","first-page":"381","DOI":"10.3138\/canlivj-2020-0009","article-title":"Rituximab-induced autoimmune hepatitis: A case study and literature review","volume":"3","author":"Galiatsatos","year":"2020","journal-title":"Can Liver J"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-269312","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T15:30:30Z","timestamp":1768231830000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-269312"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":6,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,12]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/bcr-2025-269312"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-269312","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}