Correlating pathology with the clinical symptoms of methotrexate-induced leukoencephalopathy in a child with relapsed T-cell acute lymphoblastic leukemia

• Published in: Journal of pediatric hematology/oncology Vol. 36; no. 1; pp. e19 - e22
• Main Authors: Summers, Ryan J, Abramowsky, Carlos R, Cooper, Todd M
• Format: Journal Article
• Language: English
• Published: United States 01-01-2014
• Subjects: Adolescent; Antimetabolites, Antineoplastic - adverse effects; Fatal Outcome; Female; Humans; Leukoencephalopathies - chemically induced; Leukoencephalopathies - pathology; Magnetic Resonance Imaging; Methotrexate - adverse effects; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma - pathology; Recurrence
• ISSN: 1077-4114; 1536-3678
• DOI: 10.1097/MPH.0b013e31827b6adb

Intrathecal and systemic methotrexate (MTX), as well as cranial radiation, are effective modalities to prevent central nervous system relapse in childhood acute lymphoblastic leukemia. Leukoencephalopathy is a well-described adverse effect of MTX therapy and is associated with a wide range of neurological sequelae. Most recent studies of MTX-induced leukoencephalopathy have focused exclusively on imaging findings, particularly magnetic resonance imaging. Here we report a case of severe MTX-induced leukoencephalopathy with unique magnetic resonance imaging findings and pathologic correlation from a brain biopsy taken during a period of active neurological symptomatology.