levoleucovorin and Pericarditis

Primary cardiac lymphoma (PCL), defined as a lymphoma clinically mimicking cardiac disease, with the bulk of the tumor located intrapericardially, is extremely rare in immunocompetent patients. Clinical manifestations vary depending on sites of involvement in the heart and include chest pain, arrhythmias, pericardial effusion, and heart failure. Diagnosis is often difficult and may require invasive procedures; in some cases, diagnosis is not made until autopsy. Histologically, nearly all cases of PCL reported thus far have been of B-cell origin. In this report, we describe a case of PCL of T-cell origin in an adult immunocompetent patient, the second reported in the literature to the best of our knowledge, and provide a brief overview of the features of previously published PCL cases.

Topics: Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Biopsy; Bleomycin; Cyclophosphamide; Diagnostic Errors; Doxorubicin; Dyspnea; Fatal Outcome; Female; Heart Neoplasms; Humans; Immunophenotyping; L-Lactate Dehydrogenase; Leucovorin; Lymphoma, T-Cell; Magnetic Resonance Imaging; Methotrexate; Middle Aged; Neoplasm Proteins; Neoplastic Stem Cells; Pericarditis; Prednisone; T-Lymphocytes; Tachycardia; Thoracic Surgery, Video-Assisted; Vincristine; Virus Diseases

Methotrexate (MTX) is a folate antagonist widely used both as an anticancer drug and as an immunosupressant. Administration of an 8-day methotrexate and folinic acid regime may be associated with pleuritic chest pain and pneumonitis. We have reviewed the toxicity seen in 168 consecutive patients treated with low-dose MTX for persistent trophoblastic disease. Twenty-five per cent of patients developed serosal symptoms, pleurisy was the commonest complaint. The majority of patients had mild to moderate symptoms which were controlled with simple analgesia and did not necessitate a change in treatment; 11.9% had severe symptoms which necessitated a change in treatment. One patient developed a pericardial effusion and a second patient developed severe reversible peritoneal irritation. The possible aetiology and pathophysiology of methotrexate-induced serosal toxicity is discussed.

Topics: Adult; Antimetabolites, Antineoplastic; Female; Humans; Leucovorin; Methotrexate; Pericarditis; Peritonitis; Pleurisy; Pregnancy; Serositis; Trophoblastic Neoplasms; Uterine Neoplasms