{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T06:13:52Z","timestamp":1788156832821,"version":"build-2803163510"},"reference-count":12,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T00:00:00Z","timestamp":1783814400000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Methotrexate (MTX) is primarily renally excreted, making patients with end\u2010stage renal disease (ESRD) highly vulnerable to drug accumulation and toxicity. While severe drug\u2010induced hypersensitivity syndrome (DIHS) is a known life\u2010threatening adverse reaction, its association with acute central nervous system complications, specifically cerebral infarction, is exceedingly rare and poorly characterized. We report the case of a 57\u2010year\u2010old ESRD patient on peritoneal dialysis who self\u2010initiated low\u2010dose MTX (7.5\u2009mg\/week). Two weeks later, she developed a high\u2010grade fever, widespread maculopapular rash, and profound pancytopenia. A dynamic eosinophilic surge (peaking at 21.6%) subsequently unmasked the underlying DIHS (RegiSCAR score: 6). On hospital day 4, she developed abrupt aphasia and apathy; brain MRI revealed acute multifocal non\u2010territorial infarcts without large\u2010vessel stenosis. Following MTX cessation and immediate systemic corticosteroid therapy, the patient demonstrated rapid clinical and radiographic improvement, with complete infarct resolution at the three\u2010month follow\u2010up. This case illustrates that severe DIHS can manifest with acute multifocal cerebral infarction, suggesting a potential link to a cytokine\u2010driven inflammatory microvascular mechanism rather than a classic thromboembolic event. It underscores the absolute contraindication of MTX in ESRD, the critical need for patient education, and the vital role of prompt corticosteroid intervention in averting catastrophic neurological outcomes.<\/jats:p>","DOI":"10.1002\/ccr3.73142","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T03:55:47Z","timestamp":1783914947000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Methotrexate\u2010Induced Drug Hypersensitivity Syndrome Presenting With Acute Cerebral Infarction in End\u2010Stage Renal Disease: A Case Report"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6467-3368","authenticated-orcid":false,"given":"Le","family":"Mu","sequence":"first","affiliation":[{"name":"Hangzhou Hospital of Traditional Chinese Medicine Zhejiang Chinese Medical University  Hangzhou Zhejiang 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