Catatonia in a 13-Year-Old With T-Cell Lymphoblastic Lymphoma Following Intrathecal Methotrexate

Methotrexate neurotoxicity is a recognized complication in pediatric lymphoid malignancies, presenting with seizures, stroke-like episodes, or leukoencephalopathy. Catatonia is a rare and underrecognized manifestation.

A 13-year-old girl with T-cell lymphoblastic lymphoma developed agitation, confusion, and catatonia 5 days after intrathecal methotrexate. Investigations excluded structural, infectious, metabolic, and malignant causes. Psychiatry confirmed catatonia (Bush-Francis Catatonia Rating Scale 21-22). Lorazepam led to rapid improvement. Intrathecal methotrexate was later reintroduced with leucovorin rescue without recurrence.

Catatonia may represent an uncommon presentation of methotrexate neurotoxicity. Early recognition and lorazepam treatment are critical, and cautious methotrexate rechallenge may be feasible.