AUTHOR=Muñoz Julia Sabin , Santiago Alberto Díaz-De , Escudero José Cebrián , Merino J. A. García 

TITLE=Case report: Primary cytomegalovirus infection in a patient with late onset multiple sclerosis treated with dimethyl fumarate

JOURNAL=Frontiers in Neurology

VOLUME=Volume 15 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2024.1363876

DOI=10.3389/fneur.2024.1363876

ISSN=1664-2295

ABSTRACT=Background: Treatment of multiple sclerosis (MS) with delayed-release dimethyl fumarate (DMF) has shown efficacy and safety in clinical trials. However, the occurrence of infectious complications, particularly in elderly patients, remains a concern. Methods: We present the case of a 63-year-old woman with late-onset MS treated with DMF, who developed a severe primary cytomegalovirus (CMV) infection. DMF was discontinued, and antiviral treatment was initiated, resulting in complete resolution of symptoms. Results: While DMF is generally considered safe in terms of opportunistic infections, this case highlights the possibility of serious infectious complications in eldery DMF-treated patients, even without documented lymphopenia. Conclusions: Advanced age and the associated immunological changes may contribute to an inadequate immune response to MS treatments, highlighting the importance of a careful treatment choice in elderly patients with MS. Further research and specific data on the safety and efficacy of DMF in this population are required to guide clinical decision-making.