Methotrexate-related nonnecrotizing multifocal axonopathy detected by (beta)-amyloid precursor protein immunohistochemistry / In reply

Archives of Pathology & Laboratory Medicine,  Sep 2002  by Vega, Russell S,  Moore, Brian E,  Somers, Nathan P,  Smith, Thomas W

• E-mail
• Print
• Link

To the Editor.-I read with interest the article by Moore et all in the January 2002 ARCHIVES entitled "Methotrexate-Related Nonnecrotizing Multifocal Axonopathy Detected by beta-Amyloid Precursor Protein Immunohistochemistry." I found the discussion of issues related to methotrexate toxicity and immunohistochemical diagnosis to be enlightening; however, I was puzzled by the reference to "hepatic granulomas consistent with chronic transfusion therapy" as part of the autopsy findings. When stated as such, the impression is that the finding and its interpretation are without question. However, it has not been my experience that chronic transfusion therapy has any relation to granulomatous disease of the liver or any other organ, nor could I find any reference to such in standard textbooks2,3 or the medical literature. Was this statement in error, or does some relationship exist between transfusion and granulomas of which I am unaware? Interestingly, methotrexate has been used successfully to treat idiopathic granulomatous hepatitis.4

RUSSELL S. VEGA, MD

Department of Pathology

University of South Florida

College of Medicine

James A. Haley Veterans'

Affairs Hospital

Tampa, FL 33612

1. Moore BE, Somers NP, Smith TW. Methotrexate-related nonnecrotizing multifocal axonopathy detected by beta-amyloid precursor protein immunohistochemistry. Arch Pathol Lab Med. 2002;126:79-- 81.

2. Snover DC. Nonneoplastic liver disease. In: Sternberg SS. Diagnostic Surgical Pathology. Philadelphia, Pa: Lippincott Williams & Wilkins; 1999: 1509.

3. Reynolds TB, Campra JL, Peters RL. Granulomatous liver disease. In: Zakim D, Boyer TD. Hepatology: A Textbook of Liver Disease. Philadelphia, Pa: WB Saunders & Co; 1996:1472.

4. Knox TA, Kaplan NM, Gelfand JA, Wolff SM. Methotrexate treatment of idiopathic granulomatous hepatitis. Ann Intern Med. 1995;123:733.

In Reply.-We thank Dr Vega for his comments on our article. The patient had both granulomas of unclear origin and iron deposition secondary to chronic blood transfusions. We acknowledge that the 2 entities are probably not causally related.

BRIAN E. MOORE, MD

NATHAN P. SOMERS, AB

THOMAS W. SMITH, MD

Department of Pathology

University of Massachusetts

Medical School

Worcester, MA 10655

Copyright College of American Pathologists Sep 2002
Provided by ProQuest Information and Learning Company. All rights Reserved