title: Acute leukoencephalopathy due to pyrimethamine. An insight into methotrexate neurotoxicity?
abstract: A unique case of pyrimethamine-related stroke-like leukoencephalopathy is described. The imputability of the drug is discussed as well as the similarities with the well-known methotrexate neurotoxicity. Owing to the same mode of action of both drugs by inhibition of the enzyme dihydrofolate reductase, this case is highly suggestive of the pathogenetic role of methylation pathway blockade on myelin synthesis resulting in delayed demyelination. This complication could be avoided by a concurrent folinic acid supplementation.
authors.affiliation: Service de Neurologie, Hôpital Delafontaine, 2, rue du Dr Delafontaine, 93200 Saint-Denis, France. Electronic address: thomas.debroucker@ch-stdenis.fr.
authors.forename: Thomas
authors.initials: T
authors.lastname: de Broucker
authors.forename: Delphine
authors.initials: D
authors.lastname: Leclercq
authors.forename: Sergio
authors.initials: S
authors.lastname: Jarquin
authors.forename: Carole
authors.initials: C
authors.lastname: Henry
mesh_terms: D000981:Antiprotozoal Agents / Q000009:adverse effects*; D001921:Brain / Q000473:pathology; D005260:Female; D006801:Humans; D056784:Leukoencephalopathies / Q000139:chemically induced*; D008279:Magnetic Resonance Imaging; D008727:Methotrexate / Q000633:toxicity; D020258:Neurotoxicity Syndromes / Q000209:etiology / Q000503:physiopathology*; D011739:Pyrimethamine / Q000009:adverse effects*; D012173:Retinitis / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000981:Antiprotozoal Agents; D008727:Methotrexate; D011739:Pyrimethamine
keywords: Drug toxicity; Folinic acid; Leukoencephalopathy; Methotrexate; Myelin synthesis; Pyrimethamine