title: Progressive myelopathy mimicking subacute combined degeneration after intrathecal chemotherapy.
abstract: Intrathecal chemotherapy including methotrexate is well documented for neurotoxicity of diverse clinical manifestation. Acute or chronic leukoencephalopathy is the most common type of methotrexate-induced neurotoxicity, and subacute myelopathy is rare. Although its pathogenesis is not fully understood, it is postulated that direct damage of methotrexate to the central nervous system plays a major part and elevated levels of homocysteine and its excitatory amino acid neurotransmitter metabolites (homocysteic acid and cysteine sulfinic acid) could mediate, in part, MTX-associated neurotoxicity. On the while, subacute combined degeneration is a progressive degeneration of the dorsal and lateral columns of the spinal cord, mostly due to vitamin B12 deficiency. The authors report a case of a 15-year-old boy with Burkitt leukemia who developed progressive myelopathy after intrathecal triple therapy (methotrexate, cytarabine, and hydrocortisone) whose clinical and radiologic features were compatible with subacute combined degeneration. The pathogenic mechanism could be explained by biochemical alteration by methotrexate and a possible treatment strategy was discussed.
authors.affiliation: Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Youbin
authors.initials: Y
authors.lastname: Yi
authors.affiliation: Department of Pediatrics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hyung Jin
authors.initials: HJ
authors.lastname: Kang
authors.affiliation: Department of Pediatrics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hee Young
authors.initials: HY
authors.lastname: Shin
authors.affiliation: Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea keewonkimm.d@gmail.com.
authors.forename: Keewon
authors.initials: K
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002051:Burkitt Lymphoma / Q000188:drug therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D013118:Spinal Cord Diseases / Q000139:chemically induced*; D052879:Subacute Combined Degeneration / Q000503:physiopathology*
chemical_list: D000970:Antineoplastic Agents
keywords: intrathecal; methotrexate; subacute combined degeneration