Radiation myelitis in a 5-year-old girl.
Myelopathy is an uncommon complication of radiotherapy, particularly in the pediatric age group. A 5-year-old girl with acute lymphoblastic leukemia developed a severe but transient radiculopathy after intrathecal administration of methotrexate and cytarabine for an isolated central nervous system relapse. Chemotherapy was then given through an intraventricular catheter. Owing to a second central nervous system recurrence, she was treated with craniospinal radiation. The whole brain down to the level of C2 received a dose of 2400 cGy. Two months after completion of radiation, the child developed a progressive tetraparesis, and magnetic resonance imaging revealed an enhancing lesion involving the medulla and upper cervical cord. A biopsy was consistent with a treatment-related necrotizing leukoencephalopathy. This case suggests that patients who develop neurologic dysfunction when treated with methotrexate can also be particularly susceptible to radiation-related injury.
Antunes
Nuno Lobo
NL
Department of Pediatrics and Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. nloboan-tunes@hotmail.com
Wolden
Susan
S
Souweidane
Mark M
MM
Lis
Eric
E
Rosenblum
Marc
M
Steinherz
Peter G
PG
D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008279:Magnetic Resonance Imaging; D008727:Methotrexate / Q000009:adverse effects; D018482:Muscle, Skeletal / Q000473:pathology; D009187:Myelitis / Q000209:etiology*; D009336:Necrosis; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology*; D011843:Radiculopathy / Q000139:chemically induced; D011878:Radiotherapy / Q000009:adverse effects*
D007166:Immunosuppressive Agents; D008727:Methotrexate