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.
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: firstname.lastname@example.org).
Received June 22, 2012
Accepted October 27, 2012