Ayalon Itay, Friedman Shirley, Binenbaum Yoav, Oppenheimer Noga, Shiran Shelly, Grisaru-Soen Galia, Uliel-Sibony Shimrit, Glatstein Miguel, Kaplan Jennifer Melissa, Sadot Efraim
1 "Dana-Dwek" Children's Hospital, Tel Aviv, Israel.
2 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
J Investig Med High Impact Case Rep. 2019 Jan-Dec;7:2324709619862311. doi: 10.1177/2324709619862311.
High-dose methotrexate is used to treat a range of adult and childhood cancers including osteosarcoma. Significant neurotoxicity is reported in 1% to 4.5% of patients treated with high-dose methotrexate and can present in a wide variety of symptoms. We present a case of a 14-year-old boy with a recent diagnosis of osteosarcoma who presented to the emergency department with status epilepticus, altered mental status, and very high fever secondary to methotrexate neurotoxicity. We review current literature and discuss some controversies related to this state. We also describe high fever as one of the possible symptoms associated with this condition and suggest using specific magnetic resonance imaging sequence to uncover abnormal findings related to this state. Since high-dose methotrexate is not a rare treatment in this era, we believe that in addition to oncologists, emergency department and intensive care providers should be aware of the potential role of methotrexate in causing significant neurotoxicity and include it in the differential diagnosis when treating a patient presenting with new neurological symptoms in the setting of recent high-dose methotrexate treatment.
大剂量甲氨蝶呤用于治疗一系列成人和儿童癌症，包括骨肉瘤。据报道，接受大剂量甲氨蝶呤治疗的患者中有1%至4.5%会出现严重的神经毒性，且症状多种多样。我们报告了一例14岁男孩的病例，他最近被诊断为骨肉瘤，因甲氨蝶呤神经毒性导致癫痫持续状态、精神状态改变和高热，前来急诊科就诊。我们回顾了当前的文献，并讨论了与这种情况相关的一些争议。我们还将高热描述为与这种情况相关的可能症状之一，并建议使用特定的磁共振成像序列来发现与这种情况相关的异常发现。由于在这个时代大剂量甲氨蝶呤并非罕见的治疗方法，我们认为除了肿瘤学家外，急诊科和重症监护医护人员也应意识到甲氨蝶呤在引起严重神经毒性方面的潜在作用，并在治疗近期接受过大剂量甲氨蝶呤治疗且出现新的神经症状的患者时，将其纳入鉴别诊断。
