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高剂量甲氨蝶呤诱发的舞蹈手足徐动症严重发作后成功的治疗性再激发：一例报告

Successful therapeutic rechallenge after a severe episode of high dose methotrexate-induced choreoathetosis: A case report.

作者信息

Chong Lip Leong, Wong Evelyn Yi Ting, Santos-Banta Sheryl Lyn Lucero, Cheng Chee Leong, Tan Leonard, Poon Eileen Yi Ling, Somasundaram Nagavalli, Farid Mohamad, Tang Tiffany, Tao Miriam, Khoo James Boon Kheng, Shih Vivianne, Cheah Daryl Ming Zhe, Ong Choon Kiat, Lim Soon Thye, Chan Jason Yongsheng

机构信息

Division of Medical Oncology, National Cancer Centre Singapore, Singapore 169610, Republic of Singapore.

Department of Anatomical Pathology, Singapore General Hospital, Singapore 169608, Republic of Singapore.

出版信息

Mol Clin Oncol. 2019 Oct;11(4):354-358. doi: 10.3892/mco.2019.1898. Epub 2019 Jul 16.

DOI:10.3892/mco.2019.1898
PMID:31497296
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6719254/
Abstract

Methotrexate (MTX) is an essential chemotherapy drug used in the treatment of malignancies, but it is known to cause complications to the central nervous system. We report a case of severe MTX neurotoxicity in an adult presenting with choreoathetosis despite a normal clearance of MTX. High dose-MTX has been successfully rechallenged without any neurological sequelae. We reviewed the relevant literature of similar manifestations and summarized their clinical data, magnetic resonance imaging features and treatment given. None of them has recurrence of neurotoxicity. We concluded that it is safe to persist with MTX even after a previous episode of toxic leukoencephalopathy.

摘要

甲氨蝶呤（MTX）是治疗恶性肿瘤必不可少的化疗药物，但已知其会引发中枢神经系统并发症。我们报告了一例成年患者出现严重的MTX神经毒性，表现为舞蹈手足徐动症，尽管MTX清除正常。高剂量MTX再次使用成功，且未出现任何神经后遗症。我们回顾了类似表现的相关文献，并总结了它们的临床数据、磁共振成像特征及给予的治疗。这些病例均未出现神经毒性复发。我们得出结论，即使之前发生过中毒性白质脑病，继续使用MTX也是安全的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0978/6719254/5cbff79ff2a0/mco-11-04-0354-g02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0978/6719254/2f57dab96136/mco-11-04-0354-g00.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0978/6719254/a67ea6a2ebd7/mco-11-04-0354-g01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0978/6719254/5cbff79ff2a0/mco-11-04-0354-g02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0978/6719254/2f57dab96136/mco-11-04-0354-g00.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0978/6719254/a67ea6a2ebd7/mco-11-04-0354-g01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0978/6719254/5cbff79ff2a0/mco-11-04-0354-g02.jpg

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Pediatr Emerg Care. 2017 May;33(5):380. doi: 10.1097/PEC.0000000000001128.
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Stroke-like encephalopathy following high-dose intravenous methotrexate in an adolescent with osteosarcoma: a case report.一名骨肉瘤青少年患者大剂量静脉注射甲氨蝶呤后发生类中风性脑病：病例报告
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Preventing and Managing Toxicities of High-Dose Methotrexate.
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Statistical analysis of relation between plasma methotrexate concentration and toxicity in high-dose methotrexate therapy of childhood nonHodgkin lymphoma.儿童非霍奇金淋巴瘤大剂量甲氨蝶呤治疗中血浆甲氨蝶呤浓度与毒性关系的统计分析
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