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Successful Treatment of Acute Uric Acid Nephropathy with Rasburicase in a Primary Central Nervous System Lymphoma Patient Showing a Dramatic Response to Methotrexate—Case Report

Background: Primary central nervous system lymphomas (PCNSLs) are sensitive to chemotherapy. The standard treatment is high-dose methotrexate (MTX)-based chemotherapy. There are no reports of successful treatment of acute uric acid nephropathy with rasburicase after MTX administration in PCNSLs. Cas...

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Autores principales: Mouri, Yoshihiro, Natsumeda, Manabu, Okubo, Noritaka, Sato, Taro, Saito, Taiki, Shibuya, Kohei, Yamada, Shiori, On, Jotaro, Tsukamoto, Yoshihiro, Okada, Masayasu, Oishi, Makoto, Eda, Takeyoshi, Murai, Junko, Shimizu, Hiroshi, Kakita, Akiyoshi, Fujii, Yukihiko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9571497/
https://www.ncbi.nlm.nih.gov/pubmed/36233415
http://dx.doi.org/10.3390/jcm11195548
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author Mouri, Yoshihiro
Natsumeda, Manabu
Okubo, Noritaka
Sato, Taro
Saito, Taiki
Shibuya, Kohei
Yamada, Shiori
On, Jotaro
Tsukamoto, Yoshihiro
Okada, Masayasu
Oishi, Makoto
Eda, Takeyoshi
Murai, Junko
Shimizu, Hiroshi
Kakita, Akiyoshi
Fujii, Yukihiko
author_facet Mouri, Yoshihiro
Natsumeda, Manabu
Okubo, Noritaka
Sato, Taro
Saito, Taiki
Shibuya, Kohei
Yamada, Shiori
On, Jotaro
Tsukamoto, Yoshihiro
Okada, Masayasu
Oishi, Makoto
Eda, Takeyoshi
Murai, Junko
Shimizu, Hiroshi
Kakita, Akiyoshi
Fujii, Yukihiko
author_sort Mouri, Yoshihiro
collection PubMed
description Background: Primary central nervous system lymphomas (PCNSLs) are sensitive to chemotherapy. The standard treatment is high-dose methotrexate (MTX)-based chemotherapy. There are no reports of successful treatment of acute uric acid nephropathy with rasburicase after MTX administration in PCNSLs. Case presentation: A 54-year-old man with a history of gout presented with a change in character and cognitive dysfunction. MRI showed a large enhancing mass spanning the bilateral frontal lobes and the right temporal lobe. After endoscopic biopsy, an MTX, procarbazine, and vincristine (MPV) regimen was initiated for the treatment of the PCNSL. After the initiation of chemotherapy, the patient experienced a gout attack, and blood examination revealed acute renal failure (ARF) and hyperuricemia. The considered causes of ARF included MTX toxicity and acute uric acid nephropathy. As the dramatic effect of MTX was observed, treatment was continued despite ARF, most probably due to acute hyperuricemia due to tumor lysis, which was treated in parallel. After an improvement in renal function, MTX was resumed, and rasburicase was initiated to control hyperuricemia. A complete response was obtained after induction chemotherapy. Hyperuricemia was controlled with rasburicase, and renal function was preserved. Conclusions: Acute uric acid nephropathy should be considered when ARF occurs after the initiation of MTX in PCNSLs, especially in newly diagnosed PCNSL patients with large tumors or hyperuricemia.
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spelling pubmed-95714972022-10-17 Successful Treatment of Acute Uric Acid Nephropathy with Rasburicase in a Primary Central Nervous System Lymphoma Patient Showing a Dramatic Response to Methotrexate—Case Report Mouri, Yoshihiro Natsumeda, Manabu Okubo, Noritaka Sato, Taro Saito, Taiki Shibuya, Kohei Yamada, Shiori On, Jotaro Tsukamoto, Yoshihiro Okada, Masayasu Oishi, Makoto Eda, Takeyoshi Murai, Junko Shimizu, Hiroshi Kakita, Akiyoshi Fujii, Yukihiko J Clin Med Case Report Background: Primary central nervous system lymphomas (PCNSLs) are sensitive to chemotherapy. The standard treatment is high-dose methotrexate (MTX)-based chemotherapy. There are no reports of successful treatment of acute uric acid nephropathy with rasburicase after MTX administration in PCNSLs. Case presentation: A 54-year-old man with a history of gout presented with a change in character and cognitive dysfunction. MRI showed a large enhancing mass spanning the bilateral frontal lobes and the right temporal lobe. After endoscopic biopsy, an MTX, procarbazine, and vincristine (MPV) regimen was initiated for the treatment of the PCNSL. After the initiation of chemotherapy, the patient experienced a gout attack, and blood examination revealed acute renal failure (ARF) and hyperuricemia. The considered causes of ARF included MTX toxicity and acute uric acid nephropathy. As the dramatic effect of MTX was observed, treatment was continued despite ARF, most probably due to acute hyperuricemia due to tumor lysis, which was treated in parallel. After an improvement in renal function, MTX was resumed, and rasburicase was initiated to control hyperuricemia. A complete response was obtained after induction chemotherapy. Hyperuricemia was controlled with rasburicase, and renal function was preserved. Conclusions: Acute uric acid nephropathy should be considered when ARF occurs after the initiation of MTX in PCNSLs, especially in newly diagnosed PCNSL patients with large tumors or hyperuricemia. MDPI 2022-09-22 /pmc/articles/PMC9571497/ /pubmed/36233415 http://dx.doi.org/10.3390/jcm11195548 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Mouri, Yoshihiro
Natsumeda, Manabu
Okubo, Noritaka
Sato, Taro
Saito, Taiki
Shibuya, Kohei
Yamada, Shiori
On, Jotaro
Tsukamoto, Yoshihiro
Okada, Masayasu
Oishi, Makoto
Eda, Takeyoshi
Murai, Junko
Shimizu, Hiroshi
Kakita, Akiyoshi
Fujii, Yukihiko
Successful Treatment of Acute Uric Acid Nephropathy with Rasburicase in a Primary Central Nervous System Lymphoma Patient Showing a Dramatic Response to Methotrexate—Case Report
title Successful Treatment of Acute Uric Acid Nephropathy with Rasburicase in a Primary Central Nervous System Lymphoma Patient Showing a Dramatic Response to Methotrexate—Case Report
title_full Successful Treatment of Acute Uric Acid Nephropathy with Rasburicase in a Primary Central Nervous System Lymphoma Patient Showing a Dramatic Response to Methotrexate—Case Report
title_fullStr Successful Treatment of Acute Uric Acid Nephropathy with Rasburicase in a Primary Central Nervous System Lymphoma Patient Showing a Dramatic Response to Methotrexate—Case Report
title_full_unstemmed Successful Treatment of Acute Uric Acid Nephropathy with Rasburicase in a Primary Central Nervous System Lymphoma Patient Showing a Dramatic Response to Methotrexate—Case Report
title_short Successful Treatment of Acute Uric Acid Nephropathy with Rasburicase in a Primary Central Nervous System Lymphoma Patient Showing a Dramatic Response to Methotrexate—Case Report
title_sort successful treatment of acute uric acid nephropathy with rasburicase in a primary central nervous system lymphoma patient showing a dramatic response to methotrexate—case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9571497/
https://www.ncbi.nlm.nih.gov/pubmed/36233415
http://dx.doi.org/10.3390/jcm11195548
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