Necrotizing myelopathy associated with acute lymphoblastic leukemia

Abstract

The clinico-pathological findings are reported of a 16-year-old boy with acute lymphoblastic leukemia who during chemotherapy which included intrathecal Methotrexate developed a transverse cord lesion 5 months before death. Autopsy revealed necrotizing myelopathy of the T8--T10 segments and moderate lymphoblastic infiltration of the cerebrospinal meninges and spinal nerve roots. Neither parenchymal infiltration nor vascular lesions were found. The pathogenesis of this rare lesion associated with acute lymphoblastic leukemia remains obscure.

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

“…Our patient exhibited typical clinical and radiologic features of transverse myelopathy 1 day following IT infusion. Multiple case reports of transverse myelopathy following IT methotrexate have appeared in the literature, [7][8][9][10][11] but the histologic features of this phenomenon have been described only rarely and are not well established. In most reported cases, the symptoms were reversible, but in some, the neurologic symptoms progressed over hours or days, resulting in permanent deficits as in this case.…”

Necrotizing myelopathy associated with multiple myeloma

“…Necrotizing myelopathy, although very rare (1, 2, 4, 12), is a well known paraneoplastic complication of various malignant diseases, including carcinomas of lung (1, 2), breast (1, 3), prostate (4), ovary (5), and kidney (6), as well as lymphomas (4,7, 8) and acute lymphoblastic leukaemias (9,10). However, it may certainly be seen in non-cancer patients (12,13), and has been reported as a complication of various infections, including viral illnesses (13,14), and tuberculosis (15), as well as in patients with no obvious antecedent illness (4, 12,14).…”

“…Necrotizing myelopathy is a very rare paraneoplastic complication of various malignancies (1, 2), including carcinomas of the lung (1,2), breast (1, 3), prostate (4), ovary (5), and kidney (6), as well as of lymphomas (4, 7, 8) and acute lymphoblastic leukaemias (9,10). Necrotizing myelopathy has also recently been attributed to herpes simplex type 2 (HSV 2) infection, in the setting of malignancy (1 1).…”

Ascending myelopathy after chemotherapy for central nervous system acute lymphoblastic leukemia: Correlation with cerebrospinal fluid myelin basic protein

“…The syndrome of intrathecal (IT) chemotherapy-associated myelopathy has been reviewed with at least 18 cases reported in the literaure [12][13][14][15][16][17][18][19], though few with detailed neuropathologic exam [2,3,6,11,18]. Neurologic dysfunction has usually been acute in onset, though the deficits sometimes progressed or ascended over hours or days.…”