Myelopathy following intrathecal chemotherapy in a patient with acute lymphoblastic leukemia: a case report

Intrathecal chemotherapy is a standard treatment for central nervous system (CNS) involvement in acute lymphoblastic leukemia (ALL). However, it may lead to rare but severe neurotoxicity, including chemotherapy-induced myelopathy. We report a 58-year-old female with B-cell ALL who developed progressive myelopathy approximately one month after completing seven cycles of intrathecal chemotherapy for CNS relapse. She presented with bilateral lower limb weakness, sensory disturbance below the T4 level, and urinary retention. Spinal cord MRI showed T2-weighted hyperintense signals in the dorsal columns at C7-T2 without abnormal enhancement. Systemic inflammatory, autoimmune, infectious, metabolic, vascular, and leukemic infiltration etiologies were comprehensively excluded. The diagnosis of intrathecal chemotherapy-induced myelopathy was confirmed. Despite discontinuation of intrathecal chemotherapy and supportive treatment, neurological deficits remained partially irreversible at the 3-month follow-up. This case highlights that intrathecal chemotherapy-related myelopathy is a severe and potentially irreversible complication in patients with ALL undergoing CNS-directed therapy. Characteristic MRI findings and thorough differential diagnosis are essential for early recognition. Close neurological monitoring should be strengthened in neuro-oncological patients receiving intrathecal chemotherapy.