Article Text

Download PDFPDF
Systemic absorption of intrathecal methotrexate
  1. Ruchi Singhal1,
  2. Karen Daily2 and
  3. Sarah Wheeler3
  1. 1Department of Medicine, University of Florida, Gainesville, Florida, USA
  2. 2Department of Medicine, Division of Hematology and Oncology, University of Florida, Gainesville, Florida, USA
  3. 3Department of Pharmacy Services, University of Florida Health Shands Cancer Hospital, Gainesville, Florida, USA
  1. Correspondence to Dr Ruchi Singhal; ruchisinghal{at}


Leptomeningeal spread of cancer is rare, difficult to both diagnostically confirm and treat, and associated with a poor prognosis. The blood–brain barrier largely prevents sufficient penetration of systemic therapy to be effective. Direct administration of intrathecal therapy has thus been used as an alternative treatment option. We present a case of breast cancer complicated by leptomeningeal spread. Intrathecal methotrexate was initiated, and the manifestation of systemic side effects suggested systemic absorption. This was subsequently confirmed by blood work showing detectable methotrexate levels following intrathecal administration as well as resolution of symptoms with reduction in the dose of methotrexate administered.

  • Breast cancer
  • Malignant disease and immunosuppression
  • Oncology
  • Chemotherapy

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors RS drafted the manuscript and had an important role in analysis and interpretation of the case. KD analysed and revised the manuscript and directly treated the patient. SW contributed to the treatment regimen for the patient.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.