Subacute methotrexate-induced encephalopathy: features of diagnostics and treatment options. Clinical case report

Yu. V. Dinikina; Диникина Ю. В.; A. Yu. Efimtsev; Ефимцев А. Ю.; S. I. Chernova; Чернова С. И.; A. Yu. Smirnova; Смирнова А. Ю.; Yu. E. Chervonyuk; Червонюк Ю. Е.; N. Yu. Shmedik; Шмедык Н. Ю.; A. V. Rigkov; Рыжков А. В.; M. B. Belogurova; Белогурова М. Б.

doi:10.24287/1726-1708-2019-18-1-73-80

Subacute methotrexate-induced encephalopathy: features of diagnostics and treatment options. Clinical case report

Authors: Dinikina Y.V.¹^,2, Efimtsev A.Y.¹, Chernova S.I.¹, Smirnova A.Y.¹, Chervonyuk Y.E.¹, Shmedik N.Y.¹, Rigkov A.V.¹, Belogurova M.B.¹^,2
Affiliations:
1. Almazov National Medical Research Centre
2. St. Petersburg State Pediatric Medical University
Issue: Vol 18, No 1 (2019)
Pages: 73-80
Section: CLINICAL OBSERVATIONS
Submitted: 21.04.2019
Accepted: 21.04.2019
Published: 21.04.2019
URL: https://hemoncim.com/jour/article/view/228
DOI: https://doi.org/10.24287/1726-1708-2019-18-1-73-80
ID: 228

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Abstract

Methotrexate is one of the most widely used chemotherapeutic agents against a number of malignancies in children. Clinical cases of acute and subacute neurotoxicity are described in literature, but it is necessary to underline a paucity of science information concerning pathogenesis, diagnostics and treatment options for this type of complication. The features of disease manifestation, diagnostic tools and principles of treatment have been presented in the article, using the clinical observation on 15 y.o. patient with osteosarcoma of right tibia, treated according EURAMOS 2007 protocol with high-dose methotrexate 12 g/m²as a 4-hour infusion. Parents gave their consent to use information about the child in the article. One cycle of therapy was complicated with reversible subacute neurotoxicity with alternating involvement of both cerebellar hemispheres. We discuss challenges of differential diagnosis of clinical presentation, underline value of diffusion-weighted magnetic resonance imaging, treatment options, possibilities of chemotherapy continuation with high-dose methotrexate.