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Ten months after initiating subcutaneous ofatumumab following two episodes of transverse myelitis, the patient developed a large tumefactive lesion with closed-ring contrast-enhancement and intralesional microhemorrhages and was diagnosed as having a TDL by brain biopsy. After repeated intravenous methylprednisolone and plasma exchanges, the TDL gradually shrank, although a perilesional hypointense ring remained on susceptibility-weighted images. TDLs can occur even during B-cell depletion therapy; however, the underlying mechanism is not fully elucidated.<\/jats:p>","DOI":"10.1177\/13524585251370086","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T05:55:09Z","timestamp":1759211709000},"page":"244-247","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Tumefactive demyelinating lesion during B-cell depletion therapy by ofatumumab"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3818-9008","authenticated-orcid":false,"given":"Koji","family":"Shinoda","sequence":"first","affiliation":[{"name":"Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Neurology, Iizuka Hospital, Iizuka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2516-1102","authenticated-orcid":false,"given":"Katsuhisa","family":"Masaki","sequence":"additional","affiliation":[{"name":"Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayano","family":"Matsuyoshi","sequence":"additional","affiliation":[{"name":"Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuu-ichi","family":"Kira","sequence":"additional","affiliation":[{"name":"Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazunori","family":"Iwao","sequence":"additional","affiliation":[{"name":"Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Anatomy and Cell Biology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eizo","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Neurology, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0831-623X","authenticated-orcid":false,"given":"Mitsuru","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daisuke","family":"Inoue","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Iizuka Hospital, Iizuka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kei-ichiro","family":"Takase","sequence":"additional","affiliation":[{"name":"Department of Neurology, Iizuka Hospital, Iizuka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9525-4254","authenticated-orcid":false,"given":"Noriko","family":"Isobe","sequence":"additional","affiliation":[{"name":"Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,9,29]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awn098"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2017.04.003"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000206820"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000000589"},{"issue":"1","key":"e_1_3_3_6_2","article-title":"Targeting B cells to modify MS, NMOSD, and MOGAD: Part 1","volume":"8","author":"Graf J","year":"2021","unstructured":"Graf J, Mares J, Barnett M, et al. 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