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Disseminated necrotizing encephalopathy induced by methotrexate therapy alone
Y Asada1, S Kohga, A Sumiyoshi
1First Department of Pathology, Miyazaki Medical College, Japan.
Acta Pathologica Japonica
|October 1, 1988
Summary
This study examines autopsy findings in a patient who developed disseminated necrotizing encephalopathy after intrathecal methotrexate therapy for lymphoma. The findings suggest methotrexate may directly cause vascular injury, contributing to this neurological complication.
Area of Science:
- Neuropathology
- Neuro-oncology
- Toxicology
Background:
- Intrathecal methotrexate (MTX) is used for lymphoma infiltration of the central nervous system.
- Disseminated necrotizing encephalopathy is a rare but serious adverse effect of MTX therapy.
- This case report details autopsy findings in a patient who received MTX without radiation therapy.
Observation:
- Autopsy revealed pneumonia and disseminated necrotizing encephalopathy.
- Demyelinated lesions showed fibrin exudation around small vessels.
- This suggests increased vascular permeability in affected areas.
Findings:
- The pathological findings point towards primary vascular injury as a potential cause of MTX-related encephalopathy.
- Fibrin exudation indicates damage to the blood-brain barrier.
- The direct toxic effect of methotrexate on vasculature is hypothesized.
Implications:
- Understanding the pathogenesis of MTX-induced encephalopathy is crucial for patient safety.
- This research may inform strategies to mitigate MTX neurotoxicity.
- Further investigation into MTX's vascular effects is warranted in neuro-oncology.