Pediatric Hematology/Oncology and ImmunopathologyPediatric Hematology/Oncology and ImmunopathologyВопросы гематологии/онкологии и иммунопатологии в педиатрии1726-17082414-9314Fund Doctors, Innovations, Science for Children22810.24287/1726-1708-2019-18-1-73-80CLINICAL OBSERVATIONSКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯSubacute methotrexate-induced encephalopathy: features of diagnostics and treatment options. Clinical case reportПодострая метотрексат-индуцированная энцефалопатия: особенности диагностики и лечения на примере клинического наблюденияhttps://orcid.org/0000-0002-2003-0982DinikinaYu. V.ДиникинаЮ. В.
Russian Federation

Yulia V. Dinikina - MD, Head of the Department of pediiatric oncohematology and SCT Almazov NMRC.

197341, St. Petersburg, Akkuratova st., 2

Диникина Юлия Валерьевна - кандидат медицинских наук, заведующая отделением химиотерапии онкогематологических заболеваний и ТКМ для детей НМИЦ им. В.А. Алмазова.

197341, Санкт-Петербург, ул. Аккуратова, 2

dinikina_yuv@almazovcentre.ruhttps://orcid.org/0000-0003-2249-1405EfimtsevA. Yu.ЕфимцевА. Ю.
Russian Federation

St. Petersburg

Санкт-Петербург

https://orcid.org/0000-0002-8654-8565ChernovaS. I.ЧерноваС. И.
Russian Federation

St. Petersburg

Санкт-Петербург

https://orcid.org/0000-0002-5293-9568SmirnovaA. Yu.СмирноваА. Ю.
Russian Federation

St. Petersburg

Санкт-Петербург

https://orcid.org/0000-0002-2117-3467ChervonyukYu. E.ЧервонюкЮ. Е.
Russian Federation

St. Petersburg

Санкт-Петербург

ShmedikN. Yu.ШмедыкН. Ю.
Russian Federation

St. Petersburg

Санкт-Петербург

RigkovA. V.РыжковА. В.
Russian Federation

St. Petersburg

Санкт-Петербург

https://orcid.org/0000-0002-7471-7181BelogurovaM. B.БелогуроваМ. Б.
Russian Federation

St. Petersburg

Almazov National Medical Research CentreФГБУ «Национальный медицинский исследовательский центр им. В.А. Алмазова» Минздрава РоссииSt. Petersburg State Pediatric Medical UniversityФГБОУ ВО Санкт-Петербургский государственный педиатрический медицинский университет2104201918173802104201921042019Copyright ©; 2019, «D. Rogachev NMRCPHOI»Copyright ©; 2019, ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава России2019«D. Rogachev NMRCPHOI»ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава Россииhttps://creativecommons.org/licenses/by/4.0https://hemoncim.com/jour/article/view/228

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/m2 as 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.

Высокодозный метотрексат широко используется при различных онкогематологических заболеваниях у детей. Случаи тяжелой острой и подострой нейротоксичности описаны в международной литературе, однако публикаций, касающихся патогенеза, диагностики и лечения данного вида осложнений, мало. В статье представлены особенности манифестации, диагностики, принципов лечения подострой метотрексат-индуцированной нейротоксичности на примере клинического наблюдения за пациенткой 15 лет с остеогенной саркомой правой большеберцовой кости, получавшей терапию согласно протоколу EURAMOS 2007 с использованием метотрексата в дозе 12 г/м2 в виде 4-часовой инфузии. Родители дали согласие на использование информации о ребенке в статье. Один из курсов проводимой терапии осложнился развитием обратимой подострой нейротоксичности с альтернирующим вовлечением обеих гемисфер головного мозга. В статье обсуждаются трудности дифференциальной диагностики клинических проявлений, подчеркивается значение диффузно-взвешенных изображений магнитно-резонансной томографии, выбор тактики лечения, возможность продолжения противоопухолевой терапии с включением высокодозного метотрексата.

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