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Miyoshi T, Kondo T, Nishikori M, Kitawaki T, Kobayashi K, Fujimoto M, Yoshinaga N, Oka S, Asagoe K, Imashuku S, Takaori-Kondo A. Methotrexate-induced subacute myelopathy: a serious but treatable complication. J Clin Exp Hematop 2023; 63:251-256. [PMID: 38148015 PMCID: PMC10861375 DOI: 10.3960/jslrt.23041] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 12/28/2023] Open
Abstract
Subacute myelopathy is a rare but serious complication of methotrexate (MTX) that may cause paraplegia. Although its underlying mechanisms have not been fully elucidated, homocysteine is thought to play a role in the pathogenesis of this adverse effect. Herein, we report the case of a 34-years old female patient with diffuse large B-cell lymphoma who developed progressive paraplegia accompanied by dysfunctional bladder and bowel movements after treatment with a modified CODOX-M/IVAC regimen, including high-dose intravenous MTX and intrathecal (IT-) MTX. Neurological symptoms gradually improved to almost normal levels within 4.5 months of onset following treatment with a combination of S-adenosylmethionine, methionine, cyanocobalamin, and folate. During chemotherapy, including high-dose MTX and IT-MTX for hematological malignancies, MTX-induced subacute neuronal damage should be carefully evaluated, and appropriate treatment should be initiated as early as possible.
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Affiliation(s)
- Takashi Miyoshi
- Division of Hematology and Oncology, Shiga General Hospital, Moriyama, Japan
| | - Tadakazu Kondo
- Division of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Momoko Nishikori
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshio Kitawaki
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Katsuya Kobayashi
- Department of Neurology, Kyoto University, Kyoto Graduate School of Medicine, Kyoto, Japan
| | - Masakazu Fujimoto
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Noriyoshi Yoshinaga
- Division of Hematology and Oncology, Shiga General Hospital, Moriyama, Japan
| | - Satoshi Oka
- Division of Hematology and Oncology, Shiga General Hospital, Moriyama, Japan
| | - Kohsuke Asagoe
- Division of Hematology and Oncology, Shiga General Hospital, Moriyama, Japan
| | | | - Akifumi Takaori-Kondo
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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