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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: January 2014 - Volume 36 - Issue 1 - p e19–e22
doi: 10.1097/MPH.0b013e31827b6adb
Online Articles: Clinical and Laboratory Observations

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:

Received June 22, 2012

Accepted October 27, 2012

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