Methotrexate-Induced Drug Hypersensitivity Syndrome Presenting With Acute Cerebral Infarction in End-Stage Renal Disease: A Case Report.

A correction to this paper has been published: the notice, 42676766, from Europe PMC.

Overview

Authors: Le Mu¹, Cao Yu¹, Jie‐Yi Shi¹, Zhe‐Yu Dong¹, Fang‐Yu Yi¹, Ya‐Yu Li², Shao‐Jie Zhang²

ORCID iDs: Le Mu

Hangzhou Hospital of Traditional Chinese Medicine Zhejiang Chinese Medical University Hangzhou Zhejiang China
Nephrology Hangzhou Hospital of Traditional Chinese Medicine Hangzhou Zhejiang China

Institutions: Zhejiang Chinese Medical University (China); Hangzhou Hospital of Traditional Chinese Medicine (China)

Journal: Clinical case reports, volume 14, issue 7, article e73142

Dates: received 13 November 2025; accepted 3 July 2026; published online 12 July 2026

Type: Case study · Language: English

License: CC BY-NC

Identifiers: DOI 10.1002/ccr3.73142 · PMID 42445457 · PMCID PMC13357680 · OpenAlex W4416208982

Open access: gold, a free copy (OpenAlex)

Preprint: doi:10.22541/au.176313080.00505596/v1

Status: code on request

Categories: human (organism), stroke (population), clinical / translational (subfield)

Keywords: acute cerebral infarction, drug‐induced hypersensitivity syndrome, end‐stage renal disease, methotrexate

Journal subjects: Nephrology

Topic: Drug-Induced Adverse Reactions (Pharmacology, Medicine), according to OpenAlex

Funding: Construction Fund of Key Medical Disciplines of Hangzhou (2025HZGF12)

Citations: cited by 2 papers (Europe PMC); 12 references in the paper

Notices: A correction to this paper has been published (42676766, from Europe PMC)

Abstract

Methotrexate (MTX) is primarily renally excreted, making patients with end‐stage renal disease (ESRD) highly vulnerable to drug accumulation and toxicity. While severe drug‐induced hypersensitivity syndrome (DIHS) is a known life‐threatening adverse reaction, its association with acute central nervous system complications, specifically cerebral infarction, is exceedingly rare and poorly characterized. We report the case of a 57‐year‐old ESRD patient on peritoneal dialysis who self‐initiated low‐dose MTX (7.5 mg/week). Two weeks later, she developed a high‐grade fever, widespread maculopapular rash, and profound pancytopenia. A dynamic eosinophilic surge (peaking at 21.6%) subsequently unmasked the underlying DIHS (RegiSCAR score: 6). On hospital day 4, she developed abrupt aphasia and apathy; brain MRI revealed acute multifocal non‐territorial infarcts without large‐vessel stenosis. Following MTX cessation and immediate systemic corticosteroid therapy, the patient demonstrated rapid clinical and radiographic improvement, with complete infarct resolution at the three‐month follow‐up. This case illustrates that severe DIHS can manifest with acute multifocal cerebral infarction, suggesting a potential link to a cytokine‐driven inflammatory microvascular mechanism rather than a classic thromboembolic event. It underscores the absolute contraindication of MTX in ESRD, the critical need for patient education, and the vital role of prompt corticosteroid intervention in averting catastrophic neurological outcomes.

Reproduced under the paper's license (CC BY-NC), from the paper cited above.

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All raw data and code are available upon request.

Reproduced under the paper's license (CC BY-NC), from the paper cited above.

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Version 1, 27 September 2026: the first record

Recorded: type, language, journal, volume, issue, pages, dates, 7 authors, 4 keywords, 1 funder, 11 references, 1 integrity notice.

Cite

This paper

Mu, L., Yu, C., Shi, J., Dong, Z., Yi, F., Li, Y., & Zhang, S. (2026). Methotrexate-Induced Drug Hypersensitivity Syndrome Presenting With Acute Cerebral Infarction in End-Stage Renal Disease: A Case Report. Clinical case reports, 14(7), e73142. https://doi.org/10.1002/ccr3.73142

BibTeX

@article{mu2026methotrexate, author = {Mu, Le and Yu, Cao and Shi, Jie‐Yi and Dong, Zhe‐Yu and Yi, Fang‐Yu and Li, Ya‐Yu and Zhang, Shao‐Jie}, title = {{Methotrexate-Induced Drug Hypersensitivity Syndrome Presenting With Acute Cerebral Infarction in End-Stage Renal Disease: A Case Report}}, journal = {Clinical case reports}, year = {2026}, month = jul, volume = {14}, number = {7}, pages = {e73142}, publisher = {Wiley}, issn = {2050-0904}, doi = {10.1002/ccr3.73142}, url = {https://doi.org/10.1002/ccr3.73142}, pmid = {42445457}, pmcid = {PMC13357680} }

RIS

TY - JOUR AU - Mu, Le AU - Yu, Cao AU - Shi, Jie‐Yi AU - Dong, Zhe‐Yu AU - Yi, Fang‐Yu AU - Li, Ya‐Yu AU - Zhang, Shao‐Jie TI - Methotrexate-Induced Drug Hypersensitivity Syndrome Presenting With Acute Cerebral Infarction in End-Stage Renal Disease: A Case Report T2 - Clinical case reports J2 - Clin Case Rep PY - 2026 DA - 2026/07/12 VL - 14 IS - 7 SP - e73142 SN - 2050-0904 PB - Wiley DO - 10.1002/ccr3.73142 UR - https://doi.org/10.1002/ccr3.73142 LA - en ER -

CSL-JSON

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