Methotrexate myelopathy after intrathecal chemotherapy: A case report

被引：10

作者：

Murata K.-Y. ^{[1
]}

Maeba A. ^{[1
]}

Yamanegi M. ^{[1
]}

Nakanishi I. ^{[1
]}

Ito H. ^{[1
]}

机构：

[1] Department of Neurology, Wakayama Medical University, 840-1 Kimii-dera, Wakayama, Wakayama

来源：

Journal of Medical Case Reports | / 9卷 / 1期

基金：

日本学术振兴会;

关键词：

Intrathecal chemotherapy; Malignant lymphoma; Methotrexate myelopathy; S-adenosylmethionine; Subacute combined degeneration;

D O I：

10.1186/s13256-015-0597-5

中图分类号：

学科分类号：

摘要：

Introduction: Methotrexate is often administered intrathecally or into the cerebral ventricles, particularly in patients with central nervous system tumors. However, in addition to chemical arachnoiditis, methotrexate can induce severe myelopathy. Case presentation: A 59-year-old Japanese man with diffuse B-cell lymphoma who underwent systemic chemotherapy including methotrexate and 20Gy of radiotherapy received intrathecal methotrexate for recurrence. Flaccid paresis of his lower limbs and fecal and urinary incontinence appeared 1 month later. All sensations were impaired below the Th10 dermatome level. Although the clinical symptoms were compatible with transverse myelitis, T2-weighted imaging of his thoracic spinal cord demonstrated signal hyperintensity localized to the posterior and lateral funiculi, which resembled subacute combined degeneration. His serum vitamin B12, folic acid, and total homocysteine levels were within normal limits, but total homocysteine levels in his cerebrospinal fluid were elevated, suggesting spinal cord demyelination. Conclusions: Little is known of the pathogenesis of methotrexate myelopathy. A possible mechanism of methotrexate myelopathy with demyelination was suggested by the increased homocysteine levels in the cerebrospinal fluid. © 2015 Murata et al.

引用

共 11 条

[1]

Vezmar S., Becker A., Bode U., Jaehde U., Biochemical and clinical aspects of methotrexate neurotoxicity, Chemotherapy., 49, pp. 92-104, (2003)

[2]

Clark A.W., Cohen S.R., Nissenblatt M.J., Wilson S.K., Paraplegia following intrathecal chemotherapy: Neuropathologic findings and elevation of myelin basic protein, Cancer., 50, pp. 42-47, (1982)

[3]

Bates S.E., Raphaelson M.I., Price R.A., McKeever P., Cohen S., Poplack D.G., Ascending myelopathy after chemotherapy for central nervous system acute lymphoblastic leukemia: Correlation with cerebrospinal fluid myelin basic protein, Med Pediatr Oncol., 13, pp. 4-8, (1985)

[4]

Becker A., Vezmar S., Linnebank M., Pels H., Bode U., Schlegel U., Et al., Marked elevation in homocysteine and homocysteine sulfinic acid in the cerebrospinal fluid of lymphoma patients receiving intensive treatment with methotrexate, Int J Clin Pharmacol Ther., 45, pp. 504-515, (2007)

[5]

Serot J.M., Barbe F., Arning E., Bottiglieri T., Franck P., Montagne P., Et al., Homocysteine and methylmalonic acid concentrations in cerebrospinal fluid: Relation with age and Alzheimer's disease, J Neurol Neurosurg Psychiatry., 76, pp. 1585-1587, (2005)

[6]

Hyland K., Smith I., Bottiglieri T., Perry J., Wendel U., Clayton P.T., Et al., Demyelination and decreased S-adenosylmethionine in 5,10-methylenetetrahydrofolate reductase deficiency, Neurology., 38, pp. 459-462, (1988)

[7]

Ackermann R., Semmler A., Maurer G.D., Hattingen E., Fornoff F., Steinbach J.P., Et al., Methotrexate-induced myelopathy responsive to substitution of multiple folate metabolites, J Neurooncol., 97, pp. 425-427, (2010)

[8]

Lu C.H., Yao M., Liu H.M., Chen Y.F., MR findings of intrathecal chemotherapy-related myelopathy in two cases: Mimicker of subacute combined degeneration, J Neuroimaging., 17, pp. 184-187, (2007)

[9]

Counsel P., Khangure M., Myelopathy due to intrathecal chemotherapy: Magnetic resonance imaging findings, Clin Radiol., 62, pp. 172-176, (2007)

[10]

Honda D.M.S., Ujihira N., An autopsy case of methotrexate (MTX)-induced myelopathy mimicking subacute combined degeneration (SCD), Neuropathology., 31, (2011)

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