Neurological Sciences

, Volume 39, Issue 9, pp 1637–1639 | Cite as

Rapidly ascending necrotizing myelopathy with widespread brain white matter involvement following intrathecal methotrexate and cytosine arabinoside treatment in an adult with T cell acute lymphoblastic leukemia

  • C. LapucciEmail author
  • E. Capello
  • N. Romano
  • F. Guolo
  • N. Mavilio
  • L. Roccatagliata
Letter to the Editor

Dear Editor,

In this paper we described a case of a 53-year-old man, admitted to the hematology ward due to fatigue, dyspnea, and severe hyper-leukocytosis (WBC 356 × 109/l), diagnosed with T cell acute lymphoblastic leukemia through bone marrow (BM) aspirate. Flow cytometry showed strong positivity for CD1A, CD7, cyCD3, weak expression of CD34 and negativity for mCD3, CD4, CD8. After DNA extraction, two probes for minimal residual disease assessment (MRD) using clonal T cell receptor rearrangement were identified, both with high sensitivity (>1 × 10−4). Cerebrospinal fluid (CSF) was morphologically negative for leukemic blasts, with normal cellularity (< 1 cell/μl); however, flow cytometry demonstrated low-level positivity. Since the patient was in good performance status, induction treatment with a full pediatric protocol (AIEOP-BFM ALL 2009) was immediately started, alongside with conventional central nervous system (CNS) prophylaxis with triple intrathecal therapy (TIT, consisting...


Compliance with ethical standards

Ethical approval

For this type of study formal consent is not required.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Teh HS, Fadilah SA, Leong CF (2007) Transverse myelopathy following intrathecal administration of chemotherapy. Singap Med J 48(2):e46–e49Google Scholar
  2. 2.
    Watterson J, Toogood I, Nieder M, Morse M, Frierdich S, Lee Y, Moertel CL, Priest JR (1994) Excessive spinal cord toxicity from intensive central nervous system directed therapies. Cancer 74:3034–3041CrossRefPubMedGoogle Scholar
  3. 3.
    Juster-Switlyk K, Smith AG, Kovacsovics T, Stephens D, Glenn M, Palmer CA, Quigley EP, Kolb N (2017) MTHFR C677T polymorphism is associated with methotrexate-induced myelopathy risk. Neurology 88(6):603–604. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Shintaku M, Toyooka N, Koyama T, Teraoka S, Tsudo M (2014) Methotrexate myelopathy with extensive transverse necrosis: report of an autopsy case. Neuropathology 34(6):547–553. CrossRefPubMedGoogle Scholar
  5. 5.
    Cachia D, Kamiya-Matsuoka C, Pinnix CC, Chi L, Kantarjian HM, Cortes JE, Daver N, Woodman K (2015) Myelopathy following intrathecal chemotherapy in adults: a single institution experience. J Neuro-Oncol 122(2):391–398. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI)University of Genova, Ospedale Policlinico San Martino IRCCSGenoaItaly
  2. 2.Department of Health Sciences (DISSAL)University of Genoa, Ospedale Policlinico San Martino IRCCSGenoaItaly
  3. 3.Clinic of Hematology, Department of Internal Medicine (DiMI)University of Genoa, Ospedale Policlinico San Martino IRCCSGenoaItaly
  4. 4.Department of NeuroradiologyOspedale Policlinico San Martino IRCCSGenoaItaly

Personalised recommendations