Intrathecal Methotrexate-Induced Lumbosacral Polyradiculopathy: A Case Report.

Pain medicine case reports Pub Date : 2024-01-01

Eric Xu, Sean Thomas, Behnum Habibi

{"title":"Intrathecal Methotrexate-Induced Lumbosacral Polyradiculopathy: A Case Report.","authors":"Eric Xu, Sean Thomas, Behnum Habibi","doi":"","DOIUrl":null,"url":null,"abstract":"Background: Polyradiculopathy caused by intrathecal methotrexate (IT MTX) is a rare and serious complication of chemotherapy. The pathophysiology involved is likely due to a drug-induced folate deficiency and subsequent local immune reaction in the spinal cord.Case report: The authors present a 68-year-old woman with stage I breast cancer and stage III diffuse large B-cell lymphoma who developed low back pain after IT MTX treatment. Further workup revealed diffuse rope-like thickening of the cauda equina nerve roots with subtle linear low-level leptomeningeal enhancement on magnetic resonance imaging and severe primary axonal and motor polyneuropathy affecting the upper and lower extremities on electromyography/nerve conduction studies, likely a result of IT MTX toxicity. Treatment should emphasize conservative measures. Alternatively, intravenous immunoglobulin followed by intravenous methylprednisolone can be considered.Conclusions: Polyradiculopathy caused by IT MTX is a rare finding that can be treated. It would be beneficial to further study the effects of IT MTX and create treatment protocols for its adverse effects.","PeriodicalId":520525,"journal":{"name":"Pain medicine case reports","volume":"8 1","pages":"31-35"},"PeriodicalIF":0.0000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pain medicine case reports","FirstCategoryId":"1085","ListUrlMain":"","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Polyradiculopathy caused by intrathecal methotrexate (IT MTX) is a rare and serious complication of chemotherapy. The pathophysiology involved is likely due to a drug-induced folate deficiency and subsequent local immune reaction in the spinal cord.

Case report: The authors present a 68-year-old woman with stage I breast cancer and stage III diffuse large B-cell lymphoma who developed low back pain after IT MTX treatment. Further workup revealed diffuse rope-like thickening of the cauda equina nerve roots with subtle linear low-level leptomeningeal enhancement on magnetic resonance imaging and severe primary axonal and motor polyneuropathy affecting the upper and lower extremities on electromyography/nerve conduction studies, likely a result of IT MTX toxicity. Treatment should emphasize conservative measures. Alternatively, intravenous immunoglobulin followed by intravenous methylprednisolone can be considered.

Conclusions: Polyradiculopathy caused by IT MTX is a rare finding that can be treated. It would be beneficial to further study the effects of IT MTX and create treatment protocols for its adverse effects.

本刊更多论文

鞘内甲氨蝶呤诱发腰骶部多神经根病1例。

背景：鞘内甲氨蝶呤（itmtx）引起的多发性神经根病是一种罕见而严重的化疗并发症。所涉及的病理生理可能是由于药物诱导的叶酸缺乏和随后的脊髓局部免疫反应。病例报告：作者报告了一位68岁的女性，患有I期乳腺癌和III期弥漫性大b细胞淋巴瘤，在接受甲氨蝶呤治疗后出现腰痛。进一步检查显示马尾神经根弥漫性绳状增厚，磁共振成像显示轻度低水平轻脑膜线性增强，肌电图/神经传导检查显示影响上肢和下肢的严重原发性轴突和运动多发性神经病，可能是IT MTX毒性的结果。治疗应强调保守措施。或者，可以考虑静脉注射免疫球蛋白，然后静脉注射甲基强的松龙。结论：由甲氨蝶呤引起的多发性神经根病是一种罕见的可以治疗的疾病。进一步研究甲氨蝶呤的疗效，制定治疗方案，对其不良反应有一定的指导意义。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Pain medicine case reports

自引率

0.00%

发文量