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

Front Neurol. 2024 Oct 30:15:1363876. doi: 10.3389/fneur.2024.1363876. eCollection 2024.

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.

Conclusion: 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.

Keywords: dimethyl fumarate; immunosenescence; infection; late onset multiple sclerosis; safety.

Publication types

  • Case Reports

Grants and funding

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.