Fang Diana, Poznanski Noah, Arend Lois J
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD.
Division of Nephrology, Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Kidney Med. 2024 Oct 18;6(12):100924. doi: 10.1016/j.xkme.2024.100924. eCollection 2024 Dec.
Acute kidney injury secondary to methotrexate therapy for hematologic malignancies is relatively uncommon. Methotrexate crystals in these cases are rarely seen on kidney biopsy, and in particular, their appearance in tissue prepared for transmission electron microscopy has not been described. A male patient with recurrent primary central nervous system lymphoma received high-dose methotrexate and rituximab for treatment. On day 2 of cycle 3, one day after the infusion of high-dose methotrexate, the patient was found to have high levels of serum methotrexate. Shortly after, he developed acute kidney injury. A kidney biopsy was performed, which showed methotrexate crystals only on tissue submitted for electron microscopy. To our knowledge, this is the first report to characterize methotrexate crystals on toluidine blue-stained thick sections and their ultrastructure on transmission electron microscopy.
甲氨蝶呤治疗血液系统恶性肿瘤继发的急性肾损伤相对少见。在这些病例中，肾活检很少见到甲氨蝶呤晶体，尤其是其在透射电子显微镜检查所制备组织中的表现尚未见描述。一名复发性原发性中枢神经系统淋巴瘤男性患者接受大剂量甲氨蝶呤和利妥昔单抗治疗。在第3周期第2天，即输注大剂量甲氨蝶呤1天后，发现该患者血清甲氨蝶呤水平升高。此后不久，他发生了急性肾损伤。进行了肾活检，结果仅在送检电子显微镜检查的组织中发现了甲氨蝶呤晶体。据我们所知，这是第一份描述甲苯胺蓝染色厚切片上甲氨蝶呤晶体特征及其在透射电子显微镜下超微结构的报告。
