Dimethyl fumarate is an oral treatment used for relapsing-remitting multiple sclerosis (MS). Caution is required in patients with severe lymphocytopenia that persists for more than 6 months. We describe a case of rhombencephalitis caused by Listeria monocytogenes in a patient without severe lymphocytopenia who was treated with dimethyl fumarate.
A woman in her early 30s was diagnosed with MS almost 10 years earlier and was treated with glatiramer acetate, interferon beta, fingolimod, and natalizumab before starting dimethyl fumarate treatment approximately 3 years earlier. She did not report lymphocytopenia throughout dimethyl fumarate treatment. At the last outpatient visit (11 years after diagnosis and 25 months after the start of dimethyl fumarate treatment), she presented with a white blood cell count of 4900/μL (lymphocyte count, 1240/μL) (to convert cell counts to ×109/L, multiply by 0.001); the neurologic examination revealed a positive Romberg test result, impaired extraocular movement, and mild sinking of the right leg at the position test (Expanded Disability Status Scale score, 2.0).
Ruggieri S, Logoteta A, Martini G, Bozzao A, De Giglio L. Listeria monocytogenes–Induced Rhombencephalitis in a Patient With Multiple Sclerosis Treated With Dimethyl Fumarate. JAMA Neurol. Published online April 02, 2018. doi:10.1001/jamaneurol.2018.0368
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