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Intrathecal Methotrexate-Induced Lumbosacral Polyradiculopathy: A Case Report
Eric Xu1, Sean Thomas1, Behnum Habibi1
1Temple University Health System/Lewis Katz School of Medicine, Philadelphia, PA.
Background:
Polyradiculopathy caused by intrathecal methotrexate (IT MTX) is a rare and serious complication of chemotherapy. The pathophysiology involved is likely due to a drug-induced folate deficiency and subsequent local immune reaction in the spinal cord.
Case Report:
The authors present a 68-year-old woman with stage I breast cancer and stage III diffuse large B-cell lymphoma who developed low back pain after IT MTX treatment. Further workup revealed diffuse rope-like thickening of the cauda equina nerve roots with subtle linear low-level leptomeningeal enhancement on magnetic resonance imaging and severe primary axonal and motor polyneuropathy affecting the upper and lower extremities on electromyography/nerve conduction studies, likely a result of IT MTX toxicity. Treatment should emphasize conservative measures. Alternatively, intravenous immunoglobulin followed by intravenous methylprednisolone can be considered.
Conclusions:
Polyradiculopathy caused by IT MTX is a rare finding that can be treated. It would be beneficial to further study the effects of IT MTX and create treatment protocols for its adverse effects.
Insights
Intrathecal methotrexate (IT MTX) can cause rare polyradiculopathy, a nerve complication. Early diagnosis and treatment, including conservative measures or immunotherapy, are crucial for managing this serious chemotherapy side effect.
Area of Science:
- Neuro-oncology
- Chemotherapy complications
- Neurology
Background:
- Intrathecal methotrexate (IT MTX) is a chemotherapy agent used for certain cancers.
- Polyradiculopathy is a rare but serious complication associated with IT MTX administration.
- Pathophysiology may involve drug-induced folate deficiency and local immune responses in the spinal cord.
Observation:
- A 68-year-old woman with breast cancer and lymphoma developed low back pain post-IT MTX.
- MRI revealed cauda equina nerve root thickening and leptomeningeal enhancement.
- Electromyography/nerve conduction studies showed severe axonal and motor polyneuropathy.
Findings:
- The patient's symptoms and imaging findings were consistent with IT MTX-induced polyradiculopathy.
- This condition presents as a severe axonal and motor polyneuropathy.
- Diagnosis relies on clinical presentation, MRI, and electrophysiological studies.
Implications:
- Polyradiculopathy from IT MTX is a treatable condition.
- Conservative management is the primary approach.
- Immunotherapy (IVIg, IV methylprednisolone) may be considered.
- Further research is needed to establish definitive treatment protocols for IT MTX adverse effects.
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