Stomatitis, Agranulocytosis, and Multiple Sclerosis in Pregnancy

While agranulocytosis with stomatitis is not commonly seen in the primary care setting, drug reactions, especially in patients with multiple sclerosis or conditions that require immunomodulating drugs, should be thought of as a possible etiology. We report a case of a 32-year-old pregnant woman with a history of multiple sclerosis presenting with stomatitis, found to have agranulocytosis, in the outpatient setting. The patient had been initiated on ocrelizumab months prior and had an active influenza infection, both of which can be rarely associated with stomatitis and agranulocytosis.