Preprint Case Report Version 1 Preserved in Portico This version is not peer-reviewed

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

Yoshihiro Mouri
,
Manabu Natsumeda
* ORCID logo ,
Noritaka Okubo
,
Taro Sato
,
Taiki Saito
,
Shibuya Kohei
,
Shiori Yamada
,
Jotaro On
ORCID logo ,
Yoshihiro Tsukamoto
,
Masayasu Okada
ORCID logo ,
Makoto Oishi
,
Takeyoshi Eda
,
Junko Murai
,
Hiroshi Shimizu
,
Akiyoshi Kakita
ORCID logo ,
Yukihiko Fujii
Version 1 : Received: 19 July 2022 / Approved: 20 July 2022 / Online: 20 July 2022 (11:52:03 CEST)

A peer-reviewed article of this Preprint also exists.

Mouri, Y.; Natsumeda, M.; Okubo, N.; Sato, T.; Saito, T.; Shibuya, K.; Yamada, S.; On, J.; Tsukamoto, Y.; Okada, M.; Oishi, M.; Eda, T.; Murai, J.; Shimizu, H.; Kakita, A.; Fujii, Y. 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. J. Clin. Med. 2022, 11, 5548. Mouri, Y.; Natsumeda, M.; Okubo, N.; Sato, T.; Saito, T.; Shibuya, K.; Yamada, S.; On, J.; Tsukamoto, Y.; Okada, M.; Oishi, M.; Eda, T.; Murai, J.; Shimizu, H.; Kakita, A.; Fujii, Y. 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. J. Clin. Med. 2022, 11, 5548.

Abstract

Background: Primary central nervous system lymphomas (PCNSLs) are sensitive to chemotherapy. 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 PCNSL. Case presentation: A 54-year-old man with a history of gout presented with character change and memory loss. MRI showed a large, enhancing mass spanning the bilateral frontal lobes and right temporal lobe. After endoscopic biopsy, MTX, procarbazine and vincristine (MPV) regimen was initiated for treatment of PCNSL. After initiation of chemotherapy, the patient suffered from a gout attack and blood examination revealed acute renal failure (ARF) and hyperuricemia. The considered causes of ARF included MTX toxicity and acute urid acid nephropathy. Since a good response to chemotherapy was observed, the latter was assumed. After improvement of renal function, MTX was resumed, initiating rasburicase for control of 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 initiation of MTX in PCNSL. For newly diagnosed PCNSL patients with large tumors or hyperuricemia, upfront usage of rasburicase should be considered to prevent it.

Keywords

PCNSL; high-dose methotrexate; acute uric acid nephropathy; rasburicase

Subject

Medicine and Pharmacology, Oncology and Oncogenics

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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