Nagata Shuji, Sawano Miyuki, Shouji Yuki, Koga Takuma, Tanoue Shuichi
Department of Radiology, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka 830-0011, Japan.
Department of Medicine, Division of Respirology, Neurology and Rheumatology, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka 830-0011, Japan.
Radiol Case Rep. 2025 Sep 15;20(12):5984-5988. doi: 10.1016/j.radcr.2025.08.080. eCollection 2025 Dec.
We report a case of metachronous stress fractures in the bilateral lower extremities associated with methotrexate (MTX)-induced osteopathy in a 61-year-old woman. She had been treated with low-dose MTX for 4 years for rheumatoid arthritis (RA) and acute lymphoblastic leukemia (ALL). She presented with a 2-month history of right ankle pain and swelling without trauma. Magnetic resonance imaging revealed stress fractures in the distal tibial metaphysis, calcaneus, and talus. The tibial lesion appeared meander-shaped along the growth plates, hypointense on T1-weighted images, with surrounding bone marrow edema hyperintense on fat-suppressed T2-weighted images. The patient received nonweight bearing therapy while continuing low-dose MTX for maintenance of remission in ALL. Twelve months later, pain developed in the contralateral ankle, and MRI demonstrated a stress fracture in the left distal tibial metaphysis. We diagnosed metachronous stress fractures due to MTX-induced osteopathy. Although rare, clinicians and radiologists should be aware of the potential for stress fractures in the lower extremities, particularly the distal tibial metaphysis, in patients receiving low-dose MTX who present with ankle pain.
我们报告了一例61岁女性双侧下肢异时性应力性骨折，其与甲氨蝶呤（MTX）诱导的骨病相关。她因类风湿关节炎（RA）和急性淋巴细胞白血病（ALL）接受低剂量MTX治疗4年。她出现右踝关节疼痛和肿胀2个月，无外伤史。磁共振成像显示胫骨远端干骺端、跟骨和距骨有应力性骨折。胫骨病变沿生长板呈蜿蜒状，在T1加权图像上呈低信号，在脂肪抑制T2加权图像上周围骨髓水肿呈高信号。患者接受非负重治疗，同时继续使用低剂量MTX维持ALL缓解。12个月后，对侧踝关节出现疼痛，MRI显示左胫骨远端干骺端有应力性骨折。我们诊断为MTX诱导的骨病导致的异时性应力性骨折。虽然罕见，但临床医生和放射科医生应意识到，接受低剂量MTX治疗且出现踝关节疼痛的患者，下肢尤其是胫骨远端干骺端有发生应力性骨折的可能性。
