Acute fatal myeloencephalopathy after combined intrathecal chemotherapy in a child with acute lymphoblastic leukemia.
We report a case of a fatal toxic encephalomyelopathy in a 12-year-old girl due to prophylactic intrathecal injection of methotrexate and cytosine arabinoside, with a characteristic progressive symptomatology leading to death after 28 days. The location and type of neuropathological changes support the hypothesis of a direct toxic effect of methotrexate and/or cytosine arabinoside on structures directly exposed to the cerebrospinal fluid.
von der Weid
N X
NX
Pediatric Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
de Crousaz
H
H
Beck
D
D
Deonna
T
T
Miklossy
J
J
Janzer
R C
RC
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D001927:Brain Diseases / Q000139:chemically induced* / Q000473:pathology; D002648:Child; D003128:Coma / Q000139:chemically induced; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D009364:Neoplasm Recurrence, Local; D010243:Paralysis / Q000139:chemically induced; D010264:Paraplegia / Q000139:chemically induced; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D013118:Spinal Cord Diseases / Q000139:chemically induced* / Q000473:pathology
D003561:Cytarabine; D008727:Methotrexate