Journal Article

Methotrexate as a Corticosteroid-Sparing Agent in Complicated Neurocysticercosis

Edward Mitre, Kawsar R. Talaat, Michael R. Sperling and Theodore E. Nash

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 44, issue 4, pages 549-553
Published in print February 2007 | ISSN: 1058-4838
Published online February 2007 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/511040
Methotrexate as a Corticosteroid-Sparing Agent in Complicated Neurocysticercosis

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Background. A subset of patients with neurocysticercosis developed chronic or recurrent perilesional inflammation and required long-term and high-dose corticosteroid therapy. Such therapy frequently results in severe adverse effects. The purpose of this study was to determine whether methotrexate can be used as an effective corticosteroid-sparing or replacement agent in patients with complicated neurocysticercosis.

Methods. This study was a nonblinded, prospective, observational trial. Patients with neurocysticercosis who required prednisone (15 mg/day) or its equivalent for ≥2 months, were likely to require long-term corticosteroid therapy by nature of their disease, developed serious complications due to corticosteroid use, or presented with a long-term history of corticosteroid use and had continued evidence of ongoing inflammation were eligible for methotrexate treatment.

Results. Four patients are described in this study: 2 with subarachnoid neurocysticercosis, 1 with severe intraventricular and parenchymal disease, and 1 with recurrent perilesional edema around calcified lesions. Chronic inflammation due to neurocysticercosis resulted in lacunar infarcts, visual impairment, hydrocephalus, and seizures in these patients and necessitated long-term treatment with corticosteroids, which resulted in multiple adverse effects. The addition of methotrexate, prescribed at ≤20 mg/week, allowed for the successful reduction of corticosteroid use in all 4 patients and resulted in the improvement of many corticosteroid-associated adverse effects.

Conclusions. Methotrexate is a beneficial corticosteroid-sparing or replacement agent for patients with neurocysticercosis who develop chronic or recurrent perilesional inflammation

Journal Article.  3226 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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