Neurotoxicity from intrathecally administered chemotherapeutic drugs is frequent, particularly with some agents like methotrexate, which are more prone to developing adverse effects. Myelopathy ranks among the most frequently reported neurological entities; with the diagnosis being straightforward, after ruling out infectious, metabolic, autoimmune or paraneoplastic causes. Scarcity of cases precludes evidence-based recommendations for the management of these complications. The most common therapeutic approach consists of the suspension of chemotherapy, exclusion of infectious and neoplastic causes, with prompt administration of high-dose steroids. We report a 21-year-old patient with acute lymphoblastic leukaemia, who developed acute transverse myelitis and bilateral sensorineural hearing loss, after five rounds of intrathecal methotrexate and cytarabine. Although neurotoxicity from both agents has been documented, this combination has not been previously reported.
- neurology (drugs and medicines)
- haematology (incl blood transfusion)
- spinal cord
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Correction notice This article has been corrected since it was published Online First. The spelling error in the article title and discussion section has been corrected from "optica" to "otica".
Contributors SACT and CAS-R (neurology residents) contributed to the article conception, design and drafting. HJV-M (clinical neurophysiologist) performed and interpreted evoked potentials. HJV-M and BEC-L (professors of neurology) contributed to article design, revision for intellectually relevant content and critical review of the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.