TY - JOUR T1 - Reversible Leukoencephalopathy After Oral Methotrexate JF - The Journal of Rheumatology JO - J Rheumatol SP - 1906 LP - 1907 DO - 10.3899/jrheum.120152 VL - 39 IS - 9 AU - HILLE KOPPEN AU - JUDITH A. WESSELS AU - JAQUES A.P.M. EWALS AU - FRANK E.E. TREURNIET Y1 - 2012/09/01 UR - http://www.jrheum.org/content/39/9/1906.abstract N2 - To the Editor:Central nervous system (CNS) white-matter changes have been reported after high-dose intrathecal or intravenous methotrexate (MTX) chemotherapy1,2. We describe reversible brain lesions following the use of oral MTX.A 59-year-old woman developed leukoencephalopathy strictly localized in the cerebellum after treatment with oral MTX 25 mg/week for 4 years. She was diagnosed with rheumatoid arthritis (RA) 10 years earlier and initially did well, receiving sulfasalazine 1000 mg twice a day and diclofenac 75 mg twice a day. After a flare of RA disease 4 years ago, sulfasalazine was stopped and MTX 25 mg oral once a week was initiated. While she took MTX, no signs of arthritis were present. The last 6 months she complained of fatigue and subtle coordination disturbances during tennis and skiing and was referred to the neurology outpatient clinic. She reported having fallen from her bicycle several times recently and also had slurred speech for several minutes after drinking 2 glasses of wine. She complained of mood swings and increased agitation at times. In addition to MTX 25 mg once a week, she used folic acid 2.5 mg/day and diclofenac 75 mg twice a day. General and neurological examinations were … Address correspondence to Dr. Koppen, Haga Hospital - Neurology, Leywqeg 275, The Hague, Zuid Holland 2545 CH, The Netherlands. E-mail: h.koppen{at}hagaziekenhuis.nl ER -