右美沙芬治疗甲氨蝶呤诱发急性脑病1例报告
收稿日期: 2024-05-29
录用日期: 2024-08-30
网络出版日期: 2025-02-12
Dextromethorphan in the treatment of acute encephalopathy induced by methotrexate: a case report
Received date: 2024-05-29
Accepted date: 2024-08-30
Online published: 2025-02-12
目的 提高临床对甲氨蝶呤诱发的急性脑病的认识，探讨右美沙芬特异性治疗甲氨蝶呤相关中枢神经毒性的有效性和安全性。方法 回顾性分析1例大剂量甲氨蝶呤静脉注射联合甲氨蝶呤鞘注引起急性脑病的诊治经过，并对已发表文献进行复习，评估右美沙芬的潜在疗效和安全性。结果 该患儿诊断伯基特淋巴瘤IV期，纳入CNCL-B-NHL-2017 C组方案化疗，首次给予甲氨蝶呤后当天出现头痛、视物不能等临床症状，头颅MRI显示双侧枕叶皮层区及双侧小脑半球见多发斑片状T2WI高信号影，给予右美沙芬治疗后，患儿双眼视力逐渐恢复，临床症状缓解。结论 对甲氨蝶呤诱发的急性脑病，早期给予右美沙芬治疗，可能对甲氨蝶呤引起的严重神经毒性有治疗作用。
罗文弢 , 陈霁晖 , 张鑫 , 喻娟娟 . 右美沙芬治疗甲氨蝶呤诱发急性脑病1例报告[J]. 临床儿科杂志, 2025 , 43(2) : 141 -146 . DOI: 10.12372/jcp.2025.24e0546
Objective To improve the understanding of methotrexate-induced acute encephalopathy and explore the efficacy and safety of dextromethorphan in the treatment of methotrexate-induced central neurotoxicity. Methods A retrospective analysis was performed on a patient in our hospital with acute encephalopathy caused by high-dose intravenous methotrexate combined with intrathecal methotrexate. Additionally, the published literature was reviewed to evaluate the potential efficacy and safety of dextromethorphan. Results The child was diagnosed with stage IV Burkitt lymphoma and was treated with chemotherapy in the China Net Childhood Lymphoma-mature B-cell lymphoma 2017 (CNCL-B-NHL-2017) C group. On the day following the initial administration of methotrexate, the patient exhibited clinical symptoms, including headache and visual impairment, and multiple patchy T2WI hypersignal images in the bilateral occipital cortex and bilateral cerebellar hemispheres were observed on head MRI. After oral administration of dextromethorphan, there was a gradual recovery of binocular vision and a reduction in the clinical symptoms. Conclusion In the case of acute encephalopathy induced by methotrexate, early treatment with dextromethorphan may have a therapeutic effect on severe neurotoxicity induced by methotrexate.
Key words： methotrexate; neurotoxicity; dextromethorphan
| [1] | Panicker VV, Radhakrishnan SE, Kuruttukulam GV, et al. Methotrexate-induced leukoencephalopathy as a clinical and radiological mimicker of acute ischemic stroke leading to thrombolysis[J]. Cureus, 2024, 16(1): e51542. |
| [2] | Inaba H, Khan RB, Laningham FH, et al. Clinical and radiological characteristics of methotrexate-induced acute encephalopathy in pediatric patients with cancer[J]. Ann Oncol, 2008, 19(1): 178-184. |
| [3] | Rubnitz J, Relling M, Harrison P, et al. Transient encephalopathy following high-dose methotrexate treatment in childhood acute lymphoblastic leukemia[J]. Leukemia, 1998, 12(8): 1176-1181. |
| [4] | Walker RW, Allen JC, Rosen G, et al. Transient cerebral dysfunction secondary to high-dose methotrexate[J]. J Clin Oncol, 1986, 4(12): 1845-1850. |
| [5] | Vezmar S, Schüsseler P, Becker A, et al. Methotrexate‐associated alterations of the folate and methyl‐transfer pathway in the csf of ALL patients with and without symptoms of neurotoxicity[J]. Pediatr Blood Cancer, 2008, 52(1): 26-32. |
| [6] | Kishi S, Griener J, Cheng C, et al. Homocysteine, pharmacogenetics, and neurotoxicity in children with leukemia[J]. J Clin Oncol, 2003, 21(16): 3084-3091. |
| [7] | Janeway KA, Grier HE. Sequelae of osteosarcoma medical therapy: a review of rare acute toxicities and late effects[J]. Lancet Oncol, 2010, 11(7): 670-678. |
| [8] | Ziemińska E, Stafiej A, ?azarewicz JW. Role of group I metabotropic glutamate receptors and NMDA receptors in homocysteine-evoked acute neurodegeneration of cultured cerebellar granule neurones[J]. Neurochem Int, 2003, 43(4-5): 481-492. |
| [9] | Poddar R. Hyperhomocysteinemia is an emerging comorbidity in ischemic stroke[J]. Exp Neurol, 2021, 336: 113541. |
| [10] | Refsum H, Ueland PM, Kvinnsland S. Acute and long-term effects of high-dose methotrexate treatment on homocysteine in plasma and urine[J]. Cancer Res, 1986, 46(10): 5385-5391. |
| [11] | Goldin A, Venditti JM, Kline I, et al. Eradication of leukaemic cells (l1210) by methotrexate and methotrexate plus citrovorum factor[J]. Nature, 1966, 212(5070): 1548-1550. |
| [12] | Ackland SP, Schilsky RL. High-dose methotrexate: a critical reappraisal[J]. J Clin Oncol, 1987, 5(12): 2017-2031. |
| [13] | Afshar M, Birnbaum D, Golden C. Review of dextromethorphan administration in 18 patients with subacute methotrexate central nervous system toxicity[J]. Pediatr Neurol, 2014, 50(6): 625-629. |
| [14] | Silva AR, Dinis-Oliveira RJ. Pharmacokinetics and pharmacodynamics of dextromethorphan: Clinical and forensic aspects[J]. Drug Metab Rev, 2020, 52(2): 258-282. |
| [15] | Nguyen L, Thomas KL, Lucke-Wold BP, et al. Dextro-methorphan: An update on its utility for neurological and neuropsychiatric disorders[J]. Pharmacol Ther, 2016, 159: 1-22. |
| [16] | Vijayanathan V, Gulinello M, Ali N, et al. Persistent cognitive deficits, induced by intrathecal methotrexate, are associated with elevated csf concentrations of excitotoxic glutamate analogs and can be reversed by an nmda antagonist[J]. Behav Brain Res, 2011, 225(2): 491-497. |
| [17] | Drachtman RA, Cole PD, Golden CB, et al. Dextro-methorphan is effective in the treatment of subacute methotrexate neurotoxicity[J]. Pediatr Hematol Oncol, 2002, 19(5): 319-327. |
| [18] | Bettachi CJ, Kamen BA, Cush JJ. Post-methotrexate (MTX) CNS toxicity: symptom reduction with dextromethorphan[C]. Arthritis Rheum, 1999. |
| [19] | Rogers P, Pan WJ, Drachtman RA, et al. A stroke mimic: methotrexate-induced neurotoxicity in the emergency department[J]. J Emerg Med, 2017, 52(4): 559-561. |
| [20] | Schmidt LS, Kj?r TW, Schmiegelow K, et al. Eeg with extreme delta brush in young female with methotrexate neurotoxicity supports nmda receptor involvement[J]. Eur J Paediatr Neurol, 2017, 21(5): 795-797. |
| [21] | Giordano L, Akinyede O, Bhatt N, et al. Methotrexate-induced neurotoxicity in hispanic adolescents with high-risk acute leukemia—a case series[J]. J Adolesc Young Adult Oncol, 2017, 6(3): 494-498. |
| [22] | Coker SA, Pastel DA, Davis MC, et al. Methotrexate encephalopathy: two cases in adult cancer patients, who recovered with pathophysiologically based therapy[J]. SAGE Open Med Case Rep, 2017, 5: 2050313X1770687. |
| [23] | Rubin MF, Kuhn AK. Management of methotrexate‐induced neurotoxicity with aminophylline plus dextro-methorphan in a pediatric patient with pineoblastoma[J]. Pediatr Blood Cancer, 2020, 67(12): e28515. |
| [24] | Mateos MK, Marshall GM, Barbaro PM, et al. Metho-trexate-related central neurotoxicity: Clinical characteristics, risk factors and genome-wide association study in children treated for acute lymphoblastic leukemia[J]. Haematologica, 2022, 107(3): 635-643. |
| [25] | Fustino NJ, Juhl K, Leister J. Dextromethorphan administration on day 0 and day 7 for secondary prevention of methotrexate-induced neurotoxicity in childhood acute lymphoblastic leukemia: A retrospective case series[J]. J Pediatr Hematol Oncol, 2021, 43(2): e284-e287. |
| [26] | Spangler DC, Loyd CM, Skor EE. Dextromethorphan: a case study on addressing abuse of a safe and effective drug[J]. Subst Abuse Treat Prev Policy, 2016, 11(1): 22. |
/
| 〈 |
|
〉 |
沪公网安备 31011002000392号
