CVE-2025-35033 identifies a CSV injection vulnerability classified under CWE-1236 (Improper Neutralization of Formula Elements in a CSV File) in the Medical Informatics Engineering Enterprise Health software. This vulnerability arises because the application insufficiently sanitizes user-controllable input embedded in CSV files, allowing an authenticated remote attacker to inject malicious formula elements or macros into CSV exports. When a legitimate user downloads and opens the CSV file in spreadsheet applications like Microsoft Excel, these embedded formulas can execute arbitrary commands or scripts, potentially leading to unauthorized actions such as data exfiltration, privilege escalation, or malware execution. The vulnerability affects multiple recent release candidates (RC202303 through RC202503) and was addressed by the vendor in a patch released on 2025-03-14. The CVSS 4.0 base score is 6.3 (medium severity), reflecting network attack vector, low attack complexity, no privileges required beyond authentication, and user interaction needed to open the file. The vulnerability impacts confidentiality and integrity but not availability. No public exploits have been reported to date. The issue is particularly critical in healthcare environments where sensitive patient data is handled, and trust in data integrity is paramount. The vulnerability's exploitation requires an attacker to have valid credentials to the system, limiting exposure but still posing a significant risk if credentials are compromised or insider threats exist.

For European organizations, especially healthcare providers using Medical Informatics Engineering Enterprise Health, this vulnerability could lead to unauthorized execution of malicious code via CSV files, risking patient data confidentiality and integrity. Attackers could leverage this to implant malware, steal sensitive health information, or manipulate medical records, undermining trust and compliance with GDPR and other regulations. The requirement for authentication reduces the attack surface but does not eliminate risk, as credential compromise or insider threats remain possible. The impact extends to potential regulatory fines, reputational damage, and operational disruptions. Given the critical nature of healthcare services, even medium-severity vulnerabilities can have outsized consequences. Additionally, the widespread use of spreadsheet software in healthcare analytics and reporting increases the likelihood of CSV file opening, amplifying risk. The lack of known exploits in the wild suggests a window of opportunity for proactive mitigation before active exploitation occurs.

European healthcare organizations should immediately apply the vendor-provided patch released on 2025-03-14 to all affected versions of Enterprise Health. Until patching is complete, restrict access to CSV export functionality to only trusted users and monitor for unusual download activity. Implement input validation and sanitization on CSV content to neutralize formula elements, such as prefixing potentially dangerous characters ('=', '+', '-', '@') with a single quote or using CSV export libraries that automatically escape formulas. Educate staff to be cautious when opening CSV files from the system, especially those received unexpectedly or containing unusual content. Employ endpoint protection solutions capable of detecting macro-based attacks. Review and tighten authentication controls to prevent credential compromise, including multi-factor authentication and regular credential audits. Monitor logs for suspicious activities related to CSV exports and user sessions. Consider disabling CSV export features if not essential or replacing CSV with safer data formats where feasible. Conduct regular security awareness training emphasizing risks of CSV injection and social engineering.