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Correlating Pathology With the Clinical Symptoms of Methotrexate-induced Leukoencephalopathy in a Child With Relapsed T-cell Acute Lymphoblastic Leukemia

Summers, Ryan J. MD; Abramowsky, Carlos R. MD; Cooper, Todd M. DO

Journal of Pediatric Hematology/Oncology:
doi: 10.1097/MPH.0b013e31827b6adb
Online Articles: Clinical and Laboratory Observations
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.

Author Information

Departments of *Pediatrics

Pathology, Emory University School of Medicine

Aflac Cancer Center and Blood Disorders Service, Children’s Healthcare of Atlanta, Atlanta, GA

The authors declare no conflict of interest.

Reprints: Todd M. Cooper, DO, Emory Children’s Center, Division of Pediatric Hematology/Oncology, 2015 Uppergate Dr., 4th Floor, Atlanta, GA 30322 (e-mail: todd.cooper@choa.org).

Received June 22, 2012

Accepted October 27, 2012

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.