Okada Yoshihiro, Tomita Yusuke, Nishimori Hisakazu, Ueno Hiroki, Matsuura Kanji, Makino Keigo, Kidani Naoya, Muraoka Kenichiro, Hirotsune Nobuyuki, Nishino Shigeki
Department of Neurosurgery and Neuroendovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Hiroshima, Japan.
Department of Hematology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Hiroshima, Japan.
NMC Case Rep J. 2025 Jun 11;12:255-260. doi: 10.2176/jns-nmc.2024-0296. eCollection 2025.
Methotrexate-related lymphoproliferative disorder is a rare but serious complication of methotrexate treatment. Recurrent methotrexate-related lymphoproliferative disorder in the central nervous system is uncommon. An 86-year-old woman, who had been on methotrexate for 3 years to treat rheumatoid arthritis, was admitted with left hemiplegia and sensory disturbance. Brain magnetic resonance imaging revealed a right basal ganglia lesion that was hyperintense on diffusion-weighted imaging and showed patchy enhancement. Methotrexate-related lymphoproliferative disorder was suspected, and methotrexate was discontinued, which led to improvement in her symptoms and partial remission. Twenty-eight months after methotrexate cessation, the patient presented with reduced activity and left hemiparesis. Brain magnetic resonance imaging showed homogeneously enhancing lesions in the right frontal lobe, basal ganglia, and brainstem. A craniotomy for biopsy of the right frontal lobe lesion confirmed the diagnosis of methotrexate-related lymphoproliferative disorder. Whole-brain radiation (40 Gy in 20 fractions) was administered without chemotherapy due to her advanced age and poor performance status. Her symptoms improved, and she was transferred to a rehabilitation hospital. Methotrexate-related lymphoproliferative disorder of the central nervous system can recur spontaneously, even without resumption of methotrexate, making long-term follow-up necessary after methotrexate cessation.
甲氨蝶呤相关的淋巴增殖性疾病是甲氨蝶呤治疗罕见但严重的并发症。中枢神经系统复发性甲氨蝶呤相关的淋巴增殖性疾病并不常见。一名86岁女性，因类风湿关节炎服用甲氨蝶呤3年，因左侧偏瘫和感觉障碍入院。脑磁共振成像显示右侧基底节区病变，在扩散加权成像上呈高信号，并显示斑片状强化。怀疑为甲氨蝶呤相关的淋巴增殖性疾病，停用甲氨蝶呤后，患者症状改善并部分缓解。停用甲氨蝶呤28个月后，患者出现活动减少和左侧偏瘫。脑磁共振成像显示右侧额叶、基底节区和脑干有均匀强化的病变。对右侧额叶病变进行开颅活检确诊为甲氨蝶呤相关的淋巴增殖性疾病。由于患者年龄较大且身体状况较差，未进行化疗，仅给予全脑放疗（20次分割，共4 Gy）。她的症状有所改善，随后被转至康复医院。中枢神经系统甲氨蝶呤相关的淋巴增殖性疾病即使在未重新使用甲氨蝶呤的情况下也可能自发复发，因此在停用甲氨蝶呤后需要进行长期随访。
