Regression of chronic posterior leukoencephalopathy after stop of methotrexate treatment.
Posterior reversible leukoencephalopathy (PRLE) is a neurological disorder caused by a variety of pathological conditions such as high doses or long-term low-doses of immunosuppressive therapy. PRLE associated with methotrexate (MTX) is well known but it was rarely observed in adult patients submitted to long-term low-dose administration via the oral route. Here we report the case of a patient affected by psoriasis, treated by chronic oral low-dose of MTX, who presented with limb ideomotor apraxia. Magnetic resonance (MRI) of the brain showed, on T2-weighted images, a diffuse hyperintensity involving bilaterally the white matter of the occipital, parietal and frontal lobes. MTX treatment was stopped and, at the 6-month follow-up, the neuropsychological performances was improved. Two years later, the neuropsychological profile was normal and MRI showed a regression of the white matter abnormalities.
Marcon
Gabriella
G
Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy. gmarcon@istituto-besta.it
Giovagnoli
Anna Rita
AR
Mangiapane
Paola
P
Erbetta
Alessandra
A
Tagliavini
Fabrizio
F
Girotti
Floriano
F
D000284:Administration, Oral; D020240:Apraxia, Ideomotor / Q000139:chemically induced; D002540:Cerebral Cortex / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use*; D008875:Middle Aged; D054038:Posterior Leukoencephalopathy Syndrome / Q000139:chemically induced* / Q000503:physiopathology; D011565:Psoriasis / Q000188:drug therapy; D012075:Remission, Spontaneous; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D008727:Methotrexate