|
1
|
In A, Stopa BM, Cuoco JA, Stump MS, Apfel LS, Rogers CM. Central Nervous System Lymphoproliferative Disorder Secondary to Methotrexate: A Systematic Literature Review and Case Illustration. World Neurosurg 2023; 179:118-126. [PMID: 37574195 DOI: 10.1016/j.wneu.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Methotrexate is an immunosuppressant commonly used to treat inflammatory conditions, such as rheumatoid arthritis. However, albeit exceedingly rare, it can have serious adverse effects within the central nervous system (CNS), such as methotrexate-associated lymphoproliferative disorder (MTX-LPD). Literature describing the natural history, treatment options, and clinical outcomes of patients with CNS MTX-LPD remains sparse. METHODS We present a systematic literature review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and a case illustration of CNS MTX-LPD. RESULTS A systematic review of the literature revealed 12 published cases of CNS MTX-LPD, plus the case presented herein, for a total of 13 included cases. The most common indication for MTX was rheumatoid arthritis. The most common treatment for the LPD was MTX cessation (12, 92.3%), adjunct chemotherapy (2, 15.4%), total tumor resection (3, 23.1%), or steroid therapy (1, 7.7%). Treatment usually led to improvement of neurological symptoms (9, 69.2%) along with regression of the lesions (3, 23.1%) with no recurrence (6, 46.2%). Death was reported in four cases (30.8%) with a mean time from onset of 11 months. CONCLUSIONS CNS MTX-LPD should be considered in the differential diagnosis for patients who are taking MTX presenting with neurologic symptoms, as immediate withdrawal of MTX has demonstrated good prognosis.
Collapse
Affiliation(s)
- Alexander In
- Department of Neuroscience, Fralin Biomedical Research Institute, Roanoke, Virginia, USA; Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Brittany M Stopa
- Department of Neuroscience, Fralin Biomedical Research Institute, Roanoke, Virginia, USA; Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA.
| | - Joshua A Cuoco
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; Section of Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA; School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Michael S Stump
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; Department of Pathology, Carilion Clinic, Roanoke, Virginia, USA
| | - Lisa S Apfel
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; Section of Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA; School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Cara M Rogers
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; Section of Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA; School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| |
Collapse
|
|
2
|
Fujii R, Yamamoto R, Inoue Y, Fukuyo S, Yamaguchi T, Yoshimura R. An elderly man with mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) without neuropsychiatric sequelae. Clin Case Rep 2023; 11:e7219. [PMID: 37151945 PMCID: PMC10160422 DOI: 10.1002/ccr3.7219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is less common in the elderly, and most have some sequelae. However, even in the elderly, MERS may have a good prognosis, and a specific treatment is not always required.
Collapse
Affiliation(s)
- Rintaro Fujii
- Department of Palliative Care and Hemato‐oncologyWakamatsu Hospital of the University of Occupational and Environmental HealthFukuokaJapan
- Department of PsychiatryUniversity of Occupational and Environmental HealthFukuokaJapan
| | - Ryo Yamamoto
- Department of NeurologyWakamatsu Hospital of the University of Occupational and Environmental HealthFukuokaJapan
| | - Yoshino Inoue
- Department of Rheumatology and DiabetologyWakamatsu Hospital of the University of Occupational and Environmental HealthFukuokaJapan
| | - Shunsuke Fukuyo
- Department of Rheumatology and DiabetologyWakamatsu Hospital of the University of Occupational and Environmental HealthFukuokaJapan
| | - Takahiro Yamaguchi
- Department of Palliative Care and Hemato‐oncologyWakamatsu Hospital of the University of Occupational and Environmental HealthFukuokaJapan
| | - Reiji Yoshimura
- Department of PsychiatryUniversity of Occupational and Environmental HealthFukuokaJapan
| |
Collapse
|