Levin Gabriel, Chill Henry H, Rottenstreich Amihai
a Department of Obstetrics and Gynecology , Hadassah University Medical Center , Jerusalem , Israel.
Eur J Contracept Reprod Health Care. 2017 Dec;22(6):476-478. doi: 10.1080/13625187.2017.1412426. Epub 2017 Dec 20.
Ectopic pregnancy is a common condition in the field of gynaecology, often treated with methotrexate. Adverse effects are common and usually mild. Severe adverse events are rare amongst patients treated with MTX for this condition.
A 26-year-old healthy woman was admitted and treated medically with MTX for an ectopic pregnancy. The patient was treated in the standard drug labelled protocol with an intramuscular injection of 78 mg of MTX according to body surface area. Soon after, the patient presented to the emergency department with symptoms of bilateral paresthesia of the lower limbs which ascended to the pelvis. After a thorough work up and imaging via MRI a diagnosis of transverse myelitis was made. Treatment was successful with corticosteroids and symptoms subsided.
We propose that MTX should be used with caution and severe toxicity should be kept in mind with high index of awareness for any symptom development following treatment, especially neurological one.
异位妊娠是妇科领域的常见病症，通常采用甲氨蝶呤治疗。不良反应很常见且通常较轻。在接受甲氨蝶呤治疗的患者中，严重不良事件很少见。
一名26岁健康女性因异位妊娠入院并接受甲氨蝶呤药物治疗。患者按照标准药物标签方案，根据体表面积肌肉注射78毫克甲氨蝶呤。不久后，患者因双下肢感觉异常症状就诊于急诊科，该症状向上蔓延至骨盆。经过全面检查和磁共振成像（MRI）检查后，诊断为横贯性脊髓炎。使用皮质类固醇治疗成功，症状消退。
我们建议应谨慎使用甲氨蝶呤，治疗后应高度警惕任何症状的出现，尤其是神经系统症状，要牢记严重毒性反应。
