Methotrexateinduced CNS Neurotoxicity in a Child with Acute Lymphoblastic Leukemia: Case Report and Review of Literature

Acute lymphoblastic leukemia is a malignant proliferation of lymphoid cells blocked at an early stage of difterentiation. It emerges after a consecutive mutations in genes important for blood cell development. Acute lymphoblastic leukemia is the most common malignancy among children. The incidence in Lithuania is 3.2-3.6 cases per 100 000 children a year. Almost 90 percent of aftected children are cured using contemporary treatment protocols, although chemotherapy caused complications can have a deleterious effect on quality of life. Methotrexate is a widely used drug for central nervous system leukemia prophylaxis and therapy, but can be associated with significant neurotoxicity. We present a 13-year-old girl with acute T-lymphoblastic leukemia who developed central neurotoxicity after receiving high dose methotrexate. Patient experienced symptoms of dysarthria, disorientation and coma. Magnetic resonance imaging of the brain in FLAIR and DWI regmens revealed acute toxic leukoencephalopathy. In ten days clinical picture improved and chemotherapy continued without further neurotoxicity. Methotrexate can cause acute, subacute, and long-term neurotoxicity with non-specific clinical picture. Diagnosis is based on clinical features, patient history, radiologic and electrophysiologic findings, and differentiating from other causes. Methotrexate induced neurotoxicity, raises concerns rise on further administration of methotrexate. In the review of literature we analyse and present different events of methotrexate induced neurotoxicity and existing treatment strategies.