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Leukoencephalopathy in a patient taking low dose oral methotrexate therapy for rheumatoid arthritis
1Royal Adelaide Hospital, Australia.
Abstract:
We describe the case of a man who developed a dementing illness with leukoencephalopathy while receiving low dose weekly oral methotrexate (MTX) therapy for rheumatoid arthritis. The white matter changes seen on magnetic resonance imaging and computerized tomogram scan were the same as those seen in cases of leukoencephalopathy that have been reported in patients receiving intravenous or intrathecal methotrexate. Extensive investigation excluded other known causes of white matter disease. Although no improvement either subjectively or objectively occurred in his mental status after cessation of treatment with MTX, he has remained stable. We believe that this may represent a case of oral MTX induced leukoencephalopathy, which has not previously been reported.
Insights
A man developed a rare neurological condition, oral methotrexate-induced leukoencephalopathy, while undergoing treatment for rheumatoid arthritis. This case highlights a potential adverse effect of low-dose oral methotrexate on white matter.
Area of Science:
- Neurology
- Rheumatology
- Toxicology
Background:
- Methotrexate (MTX) is a widely used medication for rheumatoid arthritis.
- Neurological complications are known but rare with MTX therapy.
- Leukoencephalopathy has been reported with intravenous and intrathecal MTX administration.
Observation:
- A patient receiving low-dose weekly oral methotrexate for rheumatoid arthritis developed a progressive dementing illness.
- Neuroimaging revealed white matter changes consistent with leukoencephalopathy.
- Extensive investigations ruled out other potential causes of white matter disease.
Findings:
- The observed white matter changes were similar to those previously reported with other routes of methotrexate administration.
- This case suggests a potential link between oral methotrexate and leukoencephalopathy.
- Cessation of oral methotrexate did not lead to subjective or objective improvement in mental status, though the patient remained stable.
Implications:
- This case expands the understanding of potential neurological adverse effects associated with oral methotrexate therapy.
- It underscores the importance of considering methotrexate-induced leukoencephalopathy in patients on oral MTX presenting with neurological symptoms.
- Further research is warranted to elucidate the mechanisms and incidence of oral methotrexate-induced leukoencephalopathy.