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CASE REPORT
Year : 2013  |  Volume : 2  |  Issue : 2  |  Page : 160-162

Delayed reversible methotrexate-induced leucoencephalopathy in a four-year-old child with acute lymphoblastic leukemia


1 Department of Paediatric Medicine, Medical College and Hospital, Kolkata, India
2 Department of Radiation Oncology, Medical College and Hospital, Kolkata, India
3 Department of Neuroradiodiagnosis, Apollo Gleneagles Hospitals, Kolkata, India

Correspondence Address:
Amrita Roy
3B, Shyam Square East, Kolkata - 700 003, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-0513.113642

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Intravenous/intrathecal methotrexate (MTX) has been implicated as a major cause of treatment-related neurotoxicity particularly leukoencephalopathy in children with hematological malignancy. We report a 4-year-old boy who presented with apathy and aphasia for 1 day while on the maintenance-phase chemotherapy according to MCP 841 protocol. MRI of brain revealed bilateral symmetrical FLAIR hyperintensities in caudate and putaminal region with FLAIR hypersignal in subcortical U-fiber in left frontal lobe consistent with MTX-induced toxic leucoencephalopathy. There was spontaneous resolution of symptoms within 1 week of onset. So, in Pre-B acute lymphoblastic leukemia patients with subtle neurological deficit, this diagnosis should be kept in mind and further treatment with MTX should be carefully decided.


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