Coker Shodeinde A, Pastel David A, Davis Melissa C, Bengtson Elizabeth M, Fadul Camilo E, Lewis Lionel D
Section of Hematology and Oncology, The Norris Cotton Cancer Center, Lebanon, NH, USA.
Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
SAGE Open Med Case Rep. 2017 May 4;5:2050313X17706875. doi: 10.1177/2050313X17706875. eCollection 2017.
BACKGROUND/OBJECTIVES: Neurotoxicity is a serious and sometimes fatal adverse effect that can occur following methotrexate treatment. We describe two adult patients with hematological malignancies with methotrexate encephalopathy who recovered with dextromethorphan therapy.
: A 24-year-old male with acute lymphoblastic leukemia developed the acute onset of bilateral facial weakness and slurred speech after his first treatment with high-dose intravenous methotrexate. The clinical scenario and a head magnetic resonance imaging supported a diagnosis of methotrexate encephalopathy. Treatment with dextromethorphan was coincident with recovery. : A 65-year-old female with recurrent diffuse large B-cell lymphoma was treated with high-dose intravenous methotrexate. Two weeks after a cycle, she developed hypoactive delirium, marked lethargy, ocular ataxia, and a right-sided facial weakness. Within 2 days of starting dextromethorphan, there was improvement with clinical recovery.
These two cases suggest that -methyl d-aspartate receptor activation by homocysteine may play an important role in the pathogenesis of methotrexate neurotoxicity.
背景/目的：神经毒性是甲氨蝶呤治疗后可能发生的一种严重且有时致命的不良反应。我们描述了两名患有血液系统恶性肿瘤且发生甲氨蝶呤脑病的成年患者，他们通过右美沙芬治疗后康复。
一名24岁急性淋巴细胞白血病男性在首次接受大剂量静脉注射甲氨蝶呤治疗后，急性出现双侧面部无力和言语不清。临床症状和头部磁共振成像支持甲氨蝶呤脑病的诊断。右美沙芬治疗与康复同时发生。一名65岁复发性弥漫性大B细胞淋巴瘤女性接受大剂量静脉注射甲氨蝶呤治疗。一个疗程后两周，她出现反应迟钝性谵妄、明显嗜睡、眼球共济失调和右侧面部无力。在开始使用右美沙芬的2天内，临床症状改善并康复。
这两例病例表明，同型半胱氨酸对N-甲基-D-天冬氨酸受体的激活可能在甲氨蝶呤神经毒性的发病机制中起重要作用。
