PMC10337780_01
Magnetic resonance imagings of the brain and spinal cord. (A, B) Medulla oblongata lesions at the first attack. (C) Thoracic cord lesions at the second attack. (D, E) Cervical and thoracic cord lesions at the last attack. (F, G) Cervical and thoracic cord lesions at four months after using ofatumumab.
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It showed abnormal signals in the left posterior part of the medulla oblongata and continuous linear enhancement of the ventral meninges of the cervical spinal cord ( Figures 1A, B ). MRI showed new abnormal lesions in the spinal cord at T3-T10 levels ( Figure 1C ). On admission, the EDSS score had reached 8.5, and her disability was still progressing (MRI is shown in  Figures 1D, E ). At follow-up after 4 months of OFA treatment, her MRI lesions were significantly reduced ( Figures 1F, G ).
The time points, symptoms, AQP4-IgG titers, EDSS, serum Interleukin-6 (IL-6) level and treatment details of each attack.
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Although the test showed the peripheral CD19+B cells were sufficiently depleted (0.00%) two weeks after the first dose, she still experienced rash all over the body and urinary tract infection, which made RTX impossible for the subsequent treatment. (The time points, symptoms, AQP4-IgG titers, EDSS, serum Interleukin-6 (IL-6) levels and treatment details of each attack are shown in  Figure 2 ).
Monitoring of the percentage of CD3-CD19+ B cells.
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We dynamically and closely monitored the levels of CD19+B cells ( Figure 3 ). During the treatment with OFA (more than 10 months), the patient's symptoms were stable without recurrence, the EDSS score remained stable (EDSS=6.0), the proportion of peripheral CD19+B cells was maintained at a very low levels ( Figure 3 ), the serum immunoglobulin were maintained at normal levels in the latest follow-up (IgA 2.41g/L [1.00-4.20], IgG 12.10g/L [8.60-17.40], IgM 1.00g/L [0.50-2.80]), and no adverse events occurred.