Methotrexate-Induced Subacute Combined Degeneration in Acute Lymphoblastic Leukemia with CNS Relapse May Be Reversible

IF 0.9 Q4 HEMATOLOGY Hemato Pub Date : 2023-10-16 DOI:10.3390/hemato4040025
David Bared Dukenik, Deborah Soong, Wenhui Li, Ellen Madarang, Justin Watts, Justin Taylor
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Abstract

We describe a case of a female patient with acute lymphoblastic leukemia treated with high-dose systemic methotrexate and intrathecal methotrexate for leukemic relapse of the central nervous system. She developed complete bilateral lower-limb paralysis that was not attributable to any other cause. She was treated with folic acid, vitamin B12, methionine, S-adenosylmethionine, leucovorin, and dextromethorphan. After a 3-month period of paraplegia, she began to slowly recover motor function. She can now ambulate with assistance and continues to improve. There is a paucity of literature on methotrexate-induced subacute combined degeneration, which is typically described as irreversible. In addition to reporting our unique case, we review the published literature and call for more awareness and research in this area.
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甲氨蝶呤诱导的伴有中枢神经系统复发的急性淋巴细胞白血病亚急性合并变性可能是可逆的
我们描述了一个病例的女性患者急性淋巴细胞白血病治疗与高剂量全身甲氨蝶呤和鞘内甲氨蝶呤白血病复发的中枢神经系统。她出现了完全的双侧下肢瘫痪,不能归因于任何其他原因。给予叶酸、维生素B12、蛋氨酸、s -腺苷蛋氨酸、亚叶酸蛋白和右美沙芬治疗。截瘫3个月后,她开始慢慢恢复运动功能。她现在可以在帮助下行走,并在继续改善。文献缺乏甲氨蝶呤诱导的亚急性合并变性,这通常被描述为不可逆的。除了报告我们独特的案例外,我们还回顾了已发表的文献,并呼吁在这一领域进行更多的认识和研究。
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来源期刊
CiteScore
1.30
自引率
0.00%
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0
审稿时长
11 weeks
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