title: An unusual infection in MS patient treated with dimethyl fumarate: A case report of omphalitis.
abstract: BACKGROUND
  Notoriously the treatment of multiple sclerosis (MS) is based on the use of several different drugs, characterized by a diverse mechanism of action, efficacy and safety. Recently, progress has been made towards developing new oral immunotherapies, and dimethyl fumarate is the third oral agent approved for the treatment of relapsing-remitting forms.
  
  
  METHODS
  A 24-year-old patient, affected by relapsing remitting multiple sclerosis, started treatment in December 2014 with dimethyl fumarate. The common side effects (flushing and gastrointestinal events) of dimethyl fumarate occurred at the beginning of treatment, but resolved after 1 month. Six months later, the patient presented with serious recrudescence of the gastrointestinal event. In addition to this symptom, he had developed acute omphalitis-a very rare infection in adults.
  
  
  CONCLUSIONS
  The pathogenic role of dimethyl fumarate to induce this rare infection was probably related to changes in immunological surveillance as well as to the irritant effect of this agent on the gastrointestinal epithelium. Therefore, post-marketing studies in clinical practice are still needed to provide the necessary long-term safety data.
authors.affiliation: Multiple Sclerosis Center, Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy. Electronic address: lorena.lorefice@hotmail.it.
authors.forename: L
authors.initials: L
authors.lastname: Lorefice
authors.affiliation: Multiple Sclerosis Center, Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy. Electronic address: giusefenu@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Fenu
authors.affiliation: Department of Surgery, Colorectal Unit, University of Cagliari, Italy. Electronic address: francescocabras.1@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Cabras
authors.affiliation: Multiple Sclerosis Center, Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy. Electronic address: jessicafrau@hotmail.it.
authors.forename: J
authors.initials: J
authors.lastname: Frau
authors.affiliation: Multiple Sclerosis Center, Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy. Electronic address: gccoghe@gmail.com.
authors.forename: G C
authors.initials: GC
authors.lastname: Coghe
authors.affiliation: Radiology Unit, Binaghi Hospital, ASL 8, Cagliari, Italy. Electronic address: loiluciano@yahoo.it.
authors.forename: L
authors.initials: L
authors.lastname: Loi
authors.affiliation: Multiple Sclerosis Center, Department of Medical Sciences, University of Cagliari, Italy. Electronic address: gmarrosu@unica.it.
authors.forename: M G
authors.initials: MG
authors.lastname: Marrosu
authors.affiliation: Multiple Sclerosis Center, Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy. Electronic address: ecocco@unica.it.
authors.forename: E
authors.initials: E
authors.lastname: Cocco
mesh_terms: D034861:Abdominal Wall / Q000000981:diagnostic imaging; D000069462:Dimethyl Fumarate / Q000009:adverse effects* / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007239:Infections / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D008297:Male; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D014054:Tomography; D014472:Umbilicus; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D000069462:Dimethyl Fumarate
keywords: Acute omphalitis; Dimethyl fumarate; Gastrointestinal epithelium; Multiple sclerosis; Safety