Korean J Hematol 1998; 33(1):
Published online March 31, 1998
© The Korean Society of Hematology
수막강내 Methotrexate 주입 후 발생한 사지마비 1례
배장한, 전현정, 김도형, 고병성, 진영주, 김혜영, 이기형, 김승택
충북대학교 의과대학 내과학교실
A Case of Quadriplegia Associated with Intrathecal Methotrexate
Intrathecal administration of methotrexate(IT-MTX) is one of the standard therapies for leptomeningeal leukemia, which has little, if any, side effects, Severe neurologic
complications such as permanent paraplegia are very unusual, approximately thirty cases having been reported in the literature including one case in Korea. We experienced a permanent quadriplegia in a 23-year-old woman following repeated IT-MTX for the treatment of meningeal leukemia. Her peripheral blood had lymphoblasts which was 80% of white blood cells. These cells expressed CDl9 and HLA DR. Blasts were also detected in the cerebrospinal fluid. She was diagnosed as All(L3) with meningeal involvement. Induction chemotherapy with vincristine, prednisolone and daunorubicin, and
IT-MTX instillation two times a week was carried out. She began complaining of urinary incontinence, pain and weakness in her left leg from 10 days after the IT-MTX
started. Even though the IT-MTX was discontinued, loss of muscle power as well as sensory loss progressed upward resulting in quadriplegia. The patient showed slow and
partial recovery on upper extremities over two months, without changes below the level. As far as we khow, this is the first reported case of the quadriplegia developed after IT-MTX administration in Korea. Attention must be paid to the possibility of serious neurologic complications when IT-MTX is done.
Keywords Acute lymphoblastic leukemia; Meningeal leukemia; Intrathecal methotrexate; Quadriplegia;
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Korean J Hematol 1998; 33(1): 132-137
Published online March 31, 1998
Copyright © The Korean Society of Hematology.
수막강내 Methotrexate 주입 후 발생한 사지마비 1례
배장한, 전현정, 김도형, 고병성, 진영주, 김혜영, 이기형, 김승택
충북대학교 의과대학 내과학교실
A Case of Quadriplegia Associated with Intrathecal Methotrexate
Jang Whan Bae, Hyeon Jeong Jeon, Doe Hyoung Kim, Byeong Seong Ko, Young Joo Chin, Hye Young Kim, Ki Hyoeng Lee, Seung Taik Kim
Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju
Dankook University, Cheonan, Korea
Abstract
Intrathecal administration of methotrexate(IT-MTX) is one of the standard therapies for leptomeningeal leukemia, which has little, if any, side effects, Severe neurologic
complications such as permanent paraplegia are very unusual, approximately thirty cases having been reported in the literature including one case in Korea. We experienced a permanent quadriplegia in a 23-year-old woman following repeated IT-MTX for the treatment of meningeal leukemia. Her peripheral blood had lymphoblasts which was 80% of white blood cells. These cells expressed CDl9 and HLA DR. Blasts were also detected in the cerebrospinal fluid. She was diagnosed as All(L3) with meningeal involvement. Induction chemotherapy with vincristine, prednisolone and daunorubicin, and
IT-MTX instillation two times a week was carried out. She began complaining of urinary incontinence, pain and weakness in her left leg from 10 days after the IT-MTX
started. Even though the IT-MTX was discontinued, loss of muscle power as well as sensory loss progressed upward resulting in quadriplegia. The patient showed slow and
partial recovery on upper extremities over two months, without changes below the level. As far as we khow, this is the first reported case of the quadriplegia developed after IT-MTX administration in Korea. Attention must be paid to the possibility of serious neurologic complications when IT-MTX is done.
Keywords: Acute lymphoblastic leukemia, Meningeal leukemia, Intrathecal methotrexate, Quadriplegia,
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