Research Day
EMOTIONAL LABILITY IN AN ATYPICAL ACUTE LYMPHOBLASTIC LEUKEMIA PATIENT WITH METHOTREXATE-INDUCED LEUKOENCEPHALOPATHY
Document Type
Abstract
Date
2021
Abstract
Introduction: The manifestation of intrathecal (IT) methotrexate toxicity in patients with acute lymphoblastic leukemia (ALL) has been well documented in young patients. Adults with B-cell ALL is uncommon but there are recorded cases. Managing adverse effects is therefore an underrepresented part of the present literature.
Case Description: We present a case with a triad of unique events: A 26-year-old patient with B-cell predominant ALL, the unique symptom of emotional lability in addition to common symptoms of methotrexate-induced encephalopathy, and a unique oral treatment for leucovorin-refractive neurotoxicity. Upon hospital admission for slurred speech and emotional outbursts followed by stroke-like symptoms, a full workup revealed central nervous system (CNS) toxicity following the patient's tenth cycle of chemotherapy. An initial leucovorin rescue did not resolve the patient's neurological symptoms within 24 hours, necessitating dextromethorphan-guaifenesin administration to limit the methotrexate toxicity. The patient displayed steady improvement over the following 4 days. The slurred speech, stroke like symptoms and imaging findings enabled prompt identification of methotrexate-induced leukoencephalopathy.
Conclusions: Emotional lability is symptom of methotrexate-induced CNS toxicity that is rarely documented by published cases. However, display of extreme emotional outbursts may provide an early indication of methotrexate induced encephalopathy. The triad of unique events in this case suggests that patients with atypical demographics for a disease may present with unique symptoms that do not respond to standard treatment measures.