{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,20]],"date-time":"2025-12-20T22:23:21Z","timestamp":1766269401079,"version":"3.46.0"},"reference-count":15,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Fingolimod is an effective therapy for relapsing\u2013remitting multiple sclerosis (RRMS) but predisposes patients to opportunistic infections, including varicella\u2010zoster virus (VZV). We report a case of a 27\u2010year\u2010old Iranian man with a history of MS, stable on fingolimod for two years, who presented with worsening paresthesia and headache. His condition acutely deteriorated, leading to a diagnosis of VZV\u2010associated cerebral vasculitis, intracerebral hemorrhage, and myelitis, confirmed via cerebrospinal fluid PCR and angiography. This case underscores that patients on fingolimod can develop severe, atypical neurological complications from VZV reactivation, even in the absence of cutaneous signs. A high index of suspicion and prompt diagnostic workup are crucial for early antiviral and immunomodulatory treatment to improve outcomes.<\/jats:p>","DOI":"10.1002\/ccr3.71449","type":"journal-article","created":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T04:33:42Z","timestamp":1762922022000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Hemorrhagic Vasculitis in a Patient With Multiple Sclerosis Receiving Fingolimod"],"prefix":"10.1002","volume":"13","author":[{"given":"Farnaz","family":"Zeynali Esfahani","sequence":"first","affiliation":[{"name":"Department of Neurology, Faculty of Medicine Birjand University of Medical Sciences  Birjand Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maryam","family":"Payere","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medicine Mashhad University of Medical Sciences  Mashhad Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bahar","family":"Karimikhoshnoudian","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Islamic Azad University of Tehran Medical Sciences  Tehran Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahdieh","family":"Baghaei","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine Mashhad University of Medical Sciences  Mashhad Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7982-6317","authenticated-orcid":false,"given":"Mohammadali","family":"Nahayati","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medicine Mashhad University of Medical Sciences  Mashhad Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,11,11]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.14236"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1586\/ern.10.193"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.4103\/0975\u20107406.84467"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2014.3065"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jneuroim.2018.12.009"},{"key":"e_1_2_11_7_1","first-page":"971","article-title":"Varicella\u2010Zoster Vasculitis Presenting With Intracranial Hemorrhage","volume":"24","author":"Jain R.","year":"2003","journal-title":"American Journal of Neuroradiology"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1159\/000524359"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12035\u2010024\u201004072\u20100"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/cns.13738"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.5858\/2001\u2010125\u20100770\u2010VZVIOT"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2019.06.025"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.2147\/NDT.S343846"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.1042988"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.4103\/jfmpc.jfmpc_183_19"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/1941874419845732"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.71449","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T05:50:28Z","timestamp":1765259428000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.71449"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":15,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1002\/ccr3.71449"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.71449","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"type":"print","value":"2050-0904"},{"type":"electronic","value":"2050-0904"}],"subject":[],"published":{"date-parts":[[2025,11]]},"assertion":[{"value":"2025-09-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71449"}}