title: Correlating pathology with the clinical symptoms of methotrexate-induced leukoencephalopathy in a child with relapsed T-cell acute lymphoblastic leukemia.
abstract: 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.
authors.affiliation: Departments of *Pediatrics †Pathology, Emory University School of Medicine ‡Aflac Cancer Center and Blood Disorders Service, Children's Healthcare of Atlanta, Atlanta, GA.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Summers
authors.forename: Carlos R
authors.initials: CR
authors.lastname: Abramowsky
authors.forename: Todd M
authors.initials: TM
authors.lastname: Cooper
mesh_terms: D000293:Adolescent; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D056784:Leukoencephalopathies / Q000139:chemically induced* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008727:Methotrexate / Q000009:adverse effects*; D054218:Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000473:pathology; D012008:Recurrence
chemical_list: D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate