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Methotrexate-induced posterior reversible encephalopathy syndrome
E Aradillas1, R Arora, J Gasperino
1Department of Neurology, Drexel University College of Medicine, Philadelphia, PA 19102-1192, USA.
Journal of Clinical Pharmacy and Therapeutics
|January 8, 2011
Summary
Posterior reversible encephalopathy syndrome (PRES) can be caused by intrathecal methotrexate (MTX) in adults. This case report highlights MTX-induced PRES as a potential diagnosis for acute neurological changes in patients receiving this chemotherapy.
Area of Science:
- Neuroscience
- Oncology
- Pharmacology
Background:
- Posterior reversible encephalopathy syndrome (PRES) is a clinical entity characterized by acute neurologic deterioration, including headache, altered mental status, and seizures, often linked to vasogenic edema in posterior brain circulation.
- Methotrexate (MTX) is known to cause neurotoxicity, particularly in pediatric patients, but is considered uncommon in adults.
Observation:
- A 55-year-old woman presented with acute PRES following intrathecal MTX administration for diffuse large B-cell lymphoma.
- Clinical symptoms and radiographic evidence of PRES resolved within 5 days of discontinuing MTX treatment.
Findings:
- This case represents the first reported instance of intrathecal MTX-induced PRES in an adult patient.
- The findings suggest that MTX-induced neurotoxicity, specifically PRES, may be under-recognized in the adult population.
Implications:
- Clinicians should consider MTX-induced PRES in the differential diagnosis for adults experiencing acute neurological changes while undergoing MTX therapy.
- Increased awareness may lead to earlier diagnosis and management of this adverse event, potentially improving patient outcomes.
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