<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1726-8958</journal-id>
<journal-title><![CDATA[Revista Médica La Paz]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. Méd. La Paz]]></abbrev-journal-title>
<issn>1726-8958</issn>
<publisher>
<publisher-name><![CDATA[Colegio Médico de La Paz]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1726-89582025000100083</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[HEMATOMA SUBDURAL SUBAGUDO BILATERAL CAUSADO POR LA ADMINISTRACION DE METOTREXATO A ALTAS DOSIS Y REVERTIDA POR DESPLAZAMIENTO MOLECULAR DE RECEPTORES NMDA, EN UNA PACIENTE CON LLA-B COMÚN DE ALTO RIESGO PHI (-)]]></article-title>
<article-title xml:lang="en"><![CDATA[BILATERAL SUBACUTE SUBDURAL HEMATOMA CAUSED BY THE ADMINISTRATION OF METHOTREXATE AT HIGH DOSE AND REVERSED BY MOLECULAR DISPLACEMENT OF NMDA RECEPTORS, IN A PATIENT WITH ALL-B COMMON HIGH-RISK PHI (-)]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rocabado Calizaya]]></surname>
<given-names><![CDATA[Guillermo Omar]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Chambi Apaza]]></surname>
<given-names><![CDATA[Rosaly Silvia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Mamani Sangueza]]></surname>
<given-names><![CDATA[Nadezhda]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Panoso de los Ríos]]></surname>
<given-names><![CDATA[María Angela]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Alpire Rodríguez]]></surname>
<given-names><![CDATA[Irene Alejandra]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ancasi M.]]></surname>
<given-names><![CDATA[Aydeé]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cortez Rocha]]></surname>
<given-names><![CDATA[Julio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Instituto Oncológico del Oriente Boliviano IOOB Farmacólogo Clínico ]]></institution>
<addr-line><![CDATA[Santa Cruz ]]></addr-line>
<country>Bolivia</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Instituto Oncológico del Oriente Boliviano IOOB Medicina Interna ]]></institution>
<addr-line><![CDATA[Santa Cruz ]]></addr-line>
<country>Bolivia</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Instituto Oncológico del Oriente Boliviano IOOB  ]]></institution>
<addr-line><![CDATA[Santa Cruz ]]></addr-line>
<country>Bolivia</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Instituto Oncológico del Oriente Boliviano IOOB Oncohematologa ]]></institution>
<addr-line><![CDATA[Santa Cruz ]]></addr-line>
<country>Bolivia</country>
</aff>
<aff id="Af5">
<institution><![CDATA[,Instituto Oncológico del Oriente Boliviano IOOB Oncohematologa ]]></institution>
<addr-line><![CDATA[Santa Cruz ]]></addr-line>
<country>Bolivia</country>
</aff>
<aff id="Af6">
<institution><![CDATA[,Diagnóstico por imágenes  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="Af7">
<institution><![CDATA[,Hospital del Niño &#8221;Dr. Ovidio Aliaga Uría&#8221; Responsable de Citostáticos ]]></institution>
<addr-line><![CDATA[La Paz ]]></addr-line>
<country>Bolivia</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2025</year>
</pub-date>
<volume>31</volume>
<numero>1</numero>
<fpage>83</fpage>
<lpage>88</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.bo/scielo.php?script=sci_arttext&amp;pid=S1726-89582025000100083&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.bo/scielo.php?script=sci_abstract&amp;pid=S1726-89582025000100083&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.bo/scielo.php?script=sci_pdf&amp;pid=S1726-89582025000100083&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN: La elevada toxicidad de MTX-HD tras el empleo en enfermedades oncohematológicas como la leucemia linfoblástica aguda LLA o el linfoma de Hodgkin LH entre otras, las altas dosis administradas por vía intravenosa (IV) mayores a 5g/m2 son fundamentales con el riesgo de producir complicaciones neurológicas o convulsiones, debido a estas surge la necesidad de cuantificar a MTX, medir la capacidad enzimática y determinar los biomarcadores de lesión cerebral que son de gran utilidad para descartar dichas lesiones a causa de MTX retenido. En este trabajo se presenta el caso de una paciente de 23 años de edad sexo femenino con diagnóstico de LLA de alto riesgo y un recuento de glóbulos blancos de 2.9x103, recibió quimioterapia a base de MTX 8 g/m2; cursó con neutropenia febril sin ser revertido por el filgrastim SC ni EV modificado. Se cuantifico MTX por UV/Vis mostrando niveles elevados; la expresión y actividad enzimática bajas determinadas por CellTiterGlow y la concentración de biomarcadores de lesión cerebral en rangos patológicos por técnicas de fluorometría. Se responsabiliza a MTX como causa directa del hematoma subdural, se formó complejos de MTX tras reacción fisicoquímica de halogenación por bromo benceno y posterior desplazamiento por dextrometorfano de receptores NMDA con la finalidad de revertir el cuadro clínico, antagonizar MTX, salir de la neutropenia y conseguir el alta médica.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT: The high toxicity ofMTX-HD after use in oncohematological diseases such as acute lymphoblastic leukemia (ALL) or Hodgkin lymphoma (HL), among others, and high intravenous (IV) doses greater than 5 g/m2 are essential, with the risk of producing neurological complications or seizures. This raises the need to quantify MTX, measure enzymatic capacity, and determine brain injury biomarkers, which are very useful for ruling out injuries caused by retained MTX. This paper presents the case of a 23-year-old female patient diagnosed with high-risk ALL and a white blood cell count of 2.9x103. She received MTX-based chemotherapy at 8 g/m2. She developed febrile neutropenia, which was not reversed by SC or modified IV filgrastim. MTX was quantified by UV/Vis, showing elevated levels. Low enzyme expression and activity were determined by CellTiterGlow, and the concentration of brain injury biomarkers was within pathological ranges using fluorometry techniques. MTX was held responsible as the direct cause of the subdural hematoma. MTX complexes were formed after a physicochemical halogenation reaction by bromobenzene and subsequent displacement of NMDA receptors by dextromethorphan, with the aim of reversing the clinical picture, antagonizing MTX, reversing neutropenia, and obtaining medical discharge.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[MTX (Metotrexato)]]></kwd>
<kwd lng="es"><![CDATA[HD (Altas Dosis)]]></kwd>
<kwd lng="es"><![CDATA[TAC (Tomografía Axial Computarizada)]]></kwd>
<kwd lng="es"><![CDATA[RMN (Resonancia Magnética Nuclear)]]></kwd>
<kwd lng="es"><![CDATA[EMR (Enfermedad Minima Residual)]]></kwd>
<kwd lng="es"><![CDATA[CK-BB (Isoenzima Creatinasa Cerebral)]]></kwd>
<kwd lng="es"><![CDATA[NSE (Enolasa Neuro Especifica)]]></kwd>
<kwd lng="es"><![CDATA[HCU-L1 (Proteína Soluble Cerebral)]]></kwd>
<kwd lng="es"><![CDATA[GFAP (Proteína Acida Fibrilar de Glia)]]></kwd>
<kwd lng="en"><![CDATA[MTX (Metotrexato)]]></kwd>
<kwd lng="en"><![CDATA[HD (Altas Dosis)]]></kwd>
<kwd lng="en"><![CDATA[TAC (Tomografía Axial Computarizada)]]></kwd>
<kwd lng="en"><![CDATA[RMN (Resonancia Magnética Nuclear)]]></kwd>
<kwd lng="en"><![CDATA[EMR (Enfermedad Minima Residual)]]></kwd>
<kwd lng="en"><![CDATA[CK-BB (Isoenzima Creatinasa Cerebral)]]></kwd>
<kwd lng="en"><![CDATA[NSE (Enolasa Neuro Especifica)]]></kwd>
<kwd lng="en"><![CDATA[HCU-L1 (Proteína Soluble Cerebral)]]></kwd>
<kwd lng="en"><![CDATA[GFAP (Proteína Acida Fibrilar de Glia)]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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