{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T02:12:42Z","timestamp":1776737562919,"version":"3.51.2"},"reference-count":12,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T00:00:00Z","timestamp":1730246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2024.1363876","type":"journal-article","created":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T04:29:55Z","timestamp":1730262595000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Case report: Primary cytomegalovirus infection in a patient with late onset multiple sclerosis treated with dimethyl fumarate"],"prefix":"10.3389","volume":"15","author":[{"given":"Julia Sabin","family":"Mu\u00f1oz","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto D\u00edaz-De","family":"Santiago","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 Cebri\u00e1n","family":"Escudero","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. A. Garc\u00eda","family":"Merino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,10,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/2055217315596994","article-title":"Dimethyl fumarate-associated lymphopenia: risk factors and clinical significance","volume":"1","author":"Longbrake","year":"2015","journal-title":"Mult Scler J Exp Transl Clin"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"14","DOI":"10.3389\/fimmu.2023.1209923","article-title":"Dimethyl fumarate-related immune and transcriptional signature is associated with clinical response in multiple sclerosis-treated patients","volume":"14","author":"S\u00e1nchez-Sanz","year":"2023","journal-title":"Front Immunol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1016\/j.jns.2019.01.007","article-title":"Factors associated with dimethyl fumarate-induced lymphopenia","volume":"398","author":"Sainz de la Maza","year":"2019","journal-title":"J Neurol Sci"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"2362","DOI":"10.1007\/s00415-020-09848-7","article-title":"Tolerability and safety of dimethyl fumarate in relapsing multiple sclerosis: a prospective observational multicenter study in a real-life Spanish population","volume":"267","author":"Sabin","year":"2020","journal-title":"J Neurol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"bcr2014206991","DOI":"10.1136\/bcr-2014","article-title":"Gastritis as a manifestation of primary CMV infection in an immunocompetent host","volume":"2015","author":"Crespo","year":"2015","journal-title":"Case Rep."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1301","DOI":"10.1177\/1352458520977132","article-title":"Expanding spectrum of opportunistic infections associated with dimethyl fumarate","volume":"27","author":"Kim","year":"2021","journal-title":"Mult Scler J"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1016\/j.msard.2019.07.026","article-title":"Cytomegalovirus primary infection in a patient with multiple sclerosis treated with alemtuzumab","volume":"35","author":"Aguirre","year":"2019","journal-title":"Mult Scler Relat Disord"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e1724","DOI":"10.1212\/WNL.0000000000007262","article-title":"Effect of dimethyl fumarate on lymphocytes in RRMS: implications for clinical practice","volume":"92","author":"Mehta","year":"2019","journal-title":"Neurology"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1177\/1352458517707069","article-title":"Dimethyl fumarate induces changes in B- and T-lymphocyte function independent of the effects on absolute lymphocyte count","volume":"24","author":"Longbrake","year":"2018","journal-title":"Mult Scler J"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"10","DOI":"10.3389\/fcimb.2020.00202","article-title":"The CD4+ T cell response to human cytomegalovirus in healthy and immunocompromised people","volume":"10","author":"Lim","year":"2020","journal-title":"Front Cell Infect Microbiol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"102815","DOI":"10.1016\/j.msard.2021.102815","article-title":"Multiple sclerosis and aging: comorbidity and treatment challenges","volume":"50","author":"Ostolaza","year":"2021","journal-title":"Mult Scler Relat Disord"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"283","DOI":"10.2165\/11532120-000000000-00000","article-title":"Multiple sclerosis in the elderly patient","volume":"27","author":"Awad","year":"2010","journal-title":"Drugs Aging"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2024.1363876\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T04:29:57Z","timestamp":1730262597000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2024.1363876\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,30]]},"references-count":12,"alternative-id":["10.3389\/fneur.2024.1363876"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2024.1363876","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,30]]},"article-number":"1363876"}}