Clinical Report

Dextromethorphan in the treatment of acute encephalopathy induced by methotrexate: a case report

  • LUO Wentao ,
  • CHEN Jihui ,
  • ZHANG Xin ,
  • YU Juanjuan
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  • 1. Department of Pharmacy, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
    2. Department of Pharmacy, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong China
    3. Department of Pediatric Hematology/Oncology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China

Received date: 2024-05-29

  Accepted date: 2024-08-30

  Online published: 2025-02-12

Abstract

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.

Cite this article

LUO Wentao , CHEN Jihui , ZHANG Xin , YU Juanjuan . Dextromethorphan in the treatment of acute encephalopathy induced by methotrexate: a case report[J]. Journal of Clinical Pediatrics, 2025 , 43(2) : 141 -146 . DOI: 10.12372/jcp.2025.24e0546

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