大剂量甲氨蝶呤化疗致可逆性后部白质脑病综合征一例并文献复习

Reversible Posterior Leukoencephalopathy Syndrome Induced by High-Dose Methotrexate Chemotherapy: A Case Report and Literature Review

摘要: 目的：探讨大剂量甲氨蝶呤致可逆性后部脑病综合征(posterior reversible encephalopathy syndrome, PRES)的临床及影像学特点，提高对该病的认识。方法：回顾性分析青岛大学附属医院2021年4月收治的1例急性淋巴细胞白血病(acute lymphoblastic leukemia, ALL)患儿资料，在进行第2次大剂量甲氨蝶呤治疗时出现甲氨蝶呤代谢延迟，临床上出现头痛、抽搐、血压升高等症状，根据影像学特点及治疗后转归，并结合相关文献分析，诊断为PRES。结果：该患儿在确诊ALL后接受规范化儿童ALL方案化疗，进行第2次HD-MTX时诊断为PRES，颅脑MR平扫示双侧额顶叶可见散在斑片状略长T1长T2异常信号，2周后复查颅脑MRI平扫病变区恢复，结合病史，诊断为PRES。结论：大剂量甲氨蝶呤引起PRES较少见，临床症状不典型，早期发现、诊断有助于改善患者预后。

Abstract: Objective: To investigate the clinical and imaging characteristics of posterior reversible encephalopathy syndrome (PRES) induced by high dose methotrexate and to improve the understanding of this disease. Methods: A retrospective analysis of the Affiliated Hospital of Qingdao University in April 2021 was 1 case of a child with acute lymphoblastic leukemia (ALL) data. In the second high-dose methotrexate treatment, the metabolism of methotrexate was delayed, and symptoms such as headache, convulsion and elevated blood pressure appeared clinically. According to the imaging characteristics and treatment outcome, and combined with related literature analysis, PRES was diagnosed. Results: After the diagnosis of ALL, the child received standardized childhood ALL chemotherapy, and was diagnosed as PRES after the second hD-MTX. MRI plain scan of the brain showed scattered patchy abnormal signals with slightly long T1 and long T2 in bilateral fronto-parietal lobes. Two weeks later, MRI plain scan of the brain recovered the lesion area, and PRES was diagnosed in combination with the medical history. Conclusion: PRES caused by high dose methotrexate is rare and the clinical symptoms are not typical. Early detection and diagnosis can improve the prognosis of patients.