Peer-reviewed article
OTHR-07. CHRONIC ENCEPHALOPATHY DUE TO METHOTREXATE NEUROTOXICITY AS A RARE COMPLICATION IN A CHILD WITH LEUKEMIA: A CASE REPORT
Rafli A, Adiprabowo S, Rahmartani L, Handryastuti S ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This is a medical case report describing one child with leukemia who developed chronic brain damage as a rare side effect of methotrexate chemotherapy. The report documents the clinical presentation, imaging findings, and course of the condition. It is not about child well-being as a population-level issue, intervention effectiveness, or policy.
Key points
Limitations
This is a single case report with no comparison group or systematic evidence. It cannot tell us how common this complication is, which children are at highest risk, or how to prevent it.
Abstract
Abstract Methotrexate (MTX) is an essential component of chemotherapy for childhood acute lymphoblastic leukemia (ALL). Both intravenous (IV) and most commonly intrathecal (IT) routes of MTX have been complicated in acute, subacute, and chronic neurotoxicity syndromes. A 9-year-old girl had been diagnosed with standard risk ALL since 2011 with first chemotherapy protocol was Indonesian protocol standard risk ALL 2006 and remission in 2012. On July 2015, patient was diagnosed as relapse ALL and underwent Indonesian protocol high risk ALL 2013. The last chemotherapy protocol of patient was Indonesian protocol high risk ALL 2013 maintenance phase 89th weeks with total dosage of MTX was 336 mg (IT), 6000 mg/m2 (IV), and 2500 mg/m2 orally. Her presenting symptom was progressive decrease of consciousness since 3 months before hospital admission. First brain computed tomography (CT-Scan) and magnetic resonance imaging (MRI) revealed brain atrophy. One month later she had abnormality in behavior and functional ability with second brain CT-Scan revealed brain atrophy and lacunar infarct in left pons. This case can be in accordance with chronic encephalopathy due to MTX. It is important to recognize early complications taking the form of subclinical or symptomatic CNS damage (e.g. headache, dizziness, tremor, ataxia, aphasia, dysarthria, emotional instabilities, seizures, hemiparesis, encephalopathy) that can occur in the course of chemotherapy especially MTX. Determination of the cause of encephalopathy is associated with considerable difficulty despite the use of various diagnostic methods and also treatment of MTX neurotoxicity is mainly supportive and recovery is usually complete. Keywords: imaging, methotrexate, neurotoxicity, leukemia