Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India.
Korean J Anesthesiol. 2022 Jun;75(3):283-285. doi: 10.4097/kja.22067. Epub 2022 Mar 14.
Methotrexate is an antimetabolite drug that blocks dihydrofolate reductase and impairs cellular DNA synthesis. Administration of intravenous iodinated radiocontrast agents can cause life-threatening toxicity in patients receiving methotrexate.
A 60-year-old female patient with rheumatoid arthritis underwent a craniotomy and clipping of a distal anterior cerebral artery aneurysm. The patient had been on low-dose oral methotrexate for the previous 5 years, which was discontinued two days before surgery. The patient received the first intravenous contrast agent injection (iohexol) during diagnostic cerebral angiography one day prior to surgery (50 ml) and the second contrast dose on the first postoperative day (60 ml). The patient developed severe methotrexate toxicity, leading to fatal multiorgan failure and death following repeated contrast imaging with intravenous iohexol.
Even though low-dose oral methotrexate has minor adverse effects, life-threatening toxicity can be precipitated in the presence of iodinated contrast agents.
甲氨蝶呤是一种抗代谢药物，可阻断二氢叶酸还原酶并损害细胞 DNA 合成。静脉内给予含碘造影剂可导致正在接受甲氨蝶呤治疗的患者发生危及生命的毒性。
一位 60 岁女性类风湿关节炎患者接受了开颅术和远端大脑前动脉动脉瘤夹闭术。患者之前已接受低剂量口服甲氨蝶呤治疗 5 年，在手术前两天停药。患者在手术前一天进行诊断性脑血管造影时接受了第一次静脉内造影剂注射（碘海醇）（50ml），并在术后第一天接受了第二次造影剂剂量（60ml）。患者发生严重的甲氨蝶呤毒性，导致致命的多器官衰竭，并在反复接受静脉内碘海醇造影后死亡。
即使是低剂量口服甲氨蝶呤也有轻微的不良反应，但在存在含碘造影剂的情况下，也可能引发危及生命的毒性。
