An oral methotrexate may cause intracerebral hemorrhage

Abstract

The neurotoxicity of methotrexate (MTX) is a well-documented issue but the development of an intracerebral hematoma following the administration of oral MTX is extremely rare. A 25-year-old female with a history of hydatidiform mole underwent dilatation and curettage 2 months earlier. She was put on oral MTX regimen 7.5 mg thrice weekly. Mistakenly she was taking 22.5 mg daily for the past 2 months. She presented to us with skin rashes and seizures. Later, she developed a deteriorating state of consciousness, with a clinical diagnosis of stroke. Magnetic resonance imaging (MRI) of the brain demonstrated a large left parietal hematoma. We failed to prove brain or lung metastasis due to choriocarcinoma, vasculitis syndrome, antiphospholipid syndrome, demyelination, and infective etiology.We used the Naranjo Adverse Drug Reaction (ADR) Probability Scale and stopped MTX, and treated the patient successfully with leucovorin, dexamethasone, aminophylline, and other measures. She was discharged after 25 days of hospital stay. We concluded that an high dose oral MTX may cause intracerebral hemorrhage.