Cardiogenic shock after ocrelizumab infusion in relapsing-remitting multiple sclerosis

A 42-year-old man with relapsing-remitting multiple sclerosis and no prior cardiac history developed a severe but reversible left ventricular systolic dysfunction following ocrelizumab administration. Symptoms started 24-36 hours after the infusion and worsened over 10 days. A thorough diagnostic evaluation, including blood tests, coronary artery angiography, cardiac magnetic resonance imaging, and endomyocardial biopsy excluded ischemic or infectious causes of myocardial damage. Although cardiac complications have not previously been reported with ocrelizumab, this case suggests the drug may rarely cause reversible severe cardiac dysfunction and highlights the importance of vigilance for cardiotoxicity in people with multiple sclerosis.