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Tariq H, Gilbert A, Sharkey FE. Intrathecal Methotrexate-Induced Necrotizing Myelopathy: A Case Report and Review of Histologic Features. Clin Med Insights Pathol. 2018;11:1179555718809071doi: 10.1177/1179555718809071.
Tariq, H., Gilbert, A., & Sharkey, F. E. (2018). Intrathecal Methotrexate-Induced Necrotizing Myelopathy: A Case Report and Review of Histologic Features. Clinical medicine insights. Pathology, 111179555718809071. https://doi.org/10.1177/1179555718809071
Tariq, Hamza, et al. "Intrathecal Methotrexate-Induced Necrotizing Myelopathy: A Case Report and Review of Histologic Features." Clinical medicine insights. Pathology vol. 11 (2018): 1179555718809071. doi: https://doi.org/10.1177/1179555718809071
Tariq H, Gilbert A, Sharkey FE. Intrathecal Methotrexate-Induced Necrotizing Myelopathy: A Case Report and Review of Histologic Features. Clin Med Insights Pathol. 2018 Nov 04;11:1179555718809071. doi: 10.1177/1179555718809071. eCollection 2018. PMID: 30450009; PMCID: PMC6236481.
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Clin Med Insights Pathol. 2018 Nov 04;11:1179555718809071. doi: 10.1177/1179555718809071. eCollection 2018.

Intrathecal Methotrexate-Induced Necrotizing Myelopathy: A Case Report and Review of Histologic Features.

Clinical medicine insights. Pathology

Hamza Tariq, Andrea Gilbert, Francis E Sharkey

Affiliations

  1. Department of Pathology and Laboratory Medicine, UT Health San Antonio, San Antonio, TX, USA.

PMID: 30450009 PMCID: PMC6236481 DOI: 10.1177/1179555718809071

Abstract

Central nervous system (CNS) relapse of acute lymphoblastic leukemia (ALL) is associated with a poor prognosis. However, prophylactic measures, including intrathecal (IT) methotrexate, reduce the incidence of CNS relapse in these patients considerably. Unfortunately, IT methotrexate can cause several neurologic complications, including transverse myelopathy; ie, the development of isolated spinal cord dysfunction over hours or days following the IT infusion of methotrexate, but in the absence of a compressive lesion. Transverse myelopathy following IT methotrexate is a well-established clinical phenomenon, but the histologic features have been described only very rarely. We report the autopsy findings from a 31-year-old man with a history of T-cell ALL who received prophylactic IT methotrexate in anticipation of a bone marrow transplant. Microscopic examination showed transverse necrosis of the thoracic cord, with massive infiltration by macrophages and lymphocytes, and perivascular lymphocytic infiltrates. There was cavitary necrosis of cervical and lumbar spinal cord involving the entire gray matter and focal white matter, as well as extensive subpial vacuolar degeneration of the dorsal and lateral columns.

Keywords: Methotrexate; intrathecal; myelopathy; vacuolar degeneration

Conflict of interest statement

Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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