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A case of visual impairment caused by damage in the brain following methotrexate Ryuya Murakami 1 , Makiko Matsumoto 1 , Akiko Matsukuma 1 , Kazuko Kinoshita 1 , Shunsuke Yoshimura 2 , Hirokazu Shiraishi 2 , Akira Tsujino 2 , Takashi Kitaoka 1 1Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University 2Department of Neurology and Strokology, Nagasaki University Hospital pp.752-758
Published Date 2020/6/15
DOI https://doi.org/10.11477/mf.1410213592
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Abstract Background:Methotrexate(MTX)is regarded as beneficial in cases of malignancy and autoimmunological diseases including rheumatoid arthritis.

Purpose:To report a case who developoed impaired vision supposedly due to damage in the brain following prolonged treatment with methotrexate.

Case:A 45-year-old male presented with impaired vision in both eyes since 2 months before. He had been treated with MTX for rheumatoid arthritis since 2 years before.

Findings and Clinical Course:Corrected visual acuity was 0.4 in either eye. Perimetry showed central scotoma and enlarged blind spot. Magnetic resonance imaging(MRI)showed enhanced response in the optic nerve, optic tract, corpus callosum, and white matter in the cerebral cortex. The pathological findings were bilateral and symmetrical. Routine laboratory and cerebrospinal fluid tests gave equivocal findings. Withdrawal of MTX was followed by improved visual acuity, visual field and MRI findings 10 months later.

Conclusion:The present case illustrates that the central nervous system, including the optic nerve and tract, may be pathologically affected by prolonged treatment with MTX.


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電子版ISSN 1882-1308 印刷版ISSN 0370-5579 医学書院

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