Successful treatment of a patient with Neuro-Behçet’s disease with low-dose weekly methotrexate

Abstract

A 79-year-old man who had a history of recurrent oral ulcers, arthritis in the left knee joint and ileocecal ulcer was admitted to our hospital because of high fever, dysarthria and progressive dementia. Magnetic resonance imaging (MRI) examinations of the brain disclosed high signal intensity areas in the left pons, left midbrain, bilateral thalamus on T₂-weighted images. These lesions were detected as slightly low signal intensity areas on T₁-weighted images, some of which were ring-enhanced after the administration of gadolinium-DPTA. The cerebrospinal fluid (CSF) interleukin-6 activity was elevated remarkably (0.77 U/ml). A diagnosis of Neuro-Behçet’s disease (NB) was made and methotrexate (MTX) was started at a dose of 2.5 mg per week. After MTX therapy, MRI findings were improved and the IL-6 activity in the CSF was decreased significantly. In addition, the progression of neuropsychiatric symptoms was prevented without any side effects during MTX therapy over 3 years. It is suggested that low-dose MTX therapy might be effective in the treatment of NB.

Key words::

• Methotrexate
• Neuro-Behçet’s disease
• brain MRI
• cerebrospinal fluid
• IL-6
• central nervous system