Methotrexate-induced Transient Encephalopathy in an Adolescent and Young Adult Patient with Acute Lymphoblastic Leukemia

Kazuaki Teshima; Masaaki Kume; Rui Kondo; Kenichi Shibata; Ko Abe; Hiroaki Aono; Susumu Fushimi; Satoshi Takahashi; Satsuki Takahashi; Masahiro Saito; Naoto Takahashi

doi:10.2169/internalmedicine.5937-20

CASE REPORTS

Methotrexate-induced Transient Encephalopathy in an Adolescent and Young Adult Patient with Acute Lymphoblastic Leukemia

Kazuaki Teshima, Masaaki Kume, Rui Kondo, Kenichi Shibata, Ko Abe, Hiroaki Aono, Susumu Fushimi, Satoshi Takahashi, Satsuki Takahashi, Masahiro Saito, Naoto Takahashi

Author information

Kazuaki Teshima
Department of Hematology, Hiraka General Hospital, Japan
Department of Hematology, Nephrology and Rheumatology, Akita University Graduate School of Medicine, Japan
Masaaki Kume
Department of Hematology, Hiraka General Hospital, Japan
Rui Kondo
Department of Neurosurgery, Hiraka General Hospital, Japan
Kenichi Shibata
Department of Neurosurgery, Hiraka General Hospital, Japan
Ko Abe
Department of Hematology, Hiraka General Hospital, Japan
Department of Hematology, Nephrology and Rheumatology, Akita University Graduate School of Medicine, Japan
Hiroaki Aono
Department of Neurosurgery, Hiraka General Hospital, Japan
Susumu Fushimi
Department of Neurosurgery, Hiraka General Hospital, Japan
Satoshi Takahashi
Department of Radiology, Hiraka General Hospital, Japan
Satsuki Takahashi
Department of Diagnostic Pathology, Hiraka General Hospital, Japan
Masahiro Saito
Department of Diagnostic Pathology, Hiraka General Hospital, Japan
Naoto Takahashi
Department of Hematology, Nephrology and Rheumatology, Akita University Graduate School of Medicine, Japan

Keywords: methotrexate, transient encephalopathy, vasospasm, acute lymphoblastic leukemia, adolescent and young adult

JOURNAL OPEN ACCESS

2021 Volume 60 Issue 13 Pages 2115-2118

DOI https://doi.org/10.2169/internalmedicine.5937-20

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Abstract

A 17-year-old girl was diagnosed with acute lymphoblastic leukemia (ALL). After the administration of high-dose methotrexate (MTX) or intrathecal MTX, the patient experienced transient hemiparesis and motor aphasia. Diffusion-weighted magnetic resonance imaging showed a high-intensity lesion in the bilateral centrum semiovale, and a vasospasm was detected in the proximal segment of bilateral A1 on magnetic resonance angiography. Edaravone was administered, and leucovorin rescue treatment was continued; eventually, the patient's neurological symptoms completely resolved. This finding suggested that vasospasm might be a mechanism underlying MTX-induced transient encephalopathy in adolescent and young adult patients with ALL.

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