Development of Posterior Reversible Encephalopathy Syndrome (PRES) Following Intrathecal Methotrexate (MTX) Therapy in a Pediatric Patient: A Case Report

Öz

Posterior Reversible Encephalopathy Syndrome (PRES) is a neurological disorder characterized by headache, seizures, visual disturbances, and altered consciousness, along with distinctive magnetic resonance imaging (MRI) findings. This report presents a 4-year-old boy who developed PRES following intrathecal methotrexate administration. The patient had been diagnosed with B-cell acute lymphoblastic leukemia (B-ALL) and was started on chemotherapy according to the ALL Induction Protocol-1. Forty-eight hours after intrathecal methotrexate administration, he developed headache and projectile vomiting, followed by generalized tonic-clonic seizures, agitation, and the need for mechanical ventilation. His vital signs revealed hypertension. Brain MRI demonstrated hyperintense lesions in the bilateral parieto-occipital regions on T2-weighted and FLAIR sequences, without diffusion restriction. A diagnosis of PRES was made, and antihypertensive, anti-edema, and supportive treatments were initiated. He was extubated on day 8, and his neurological examination returned completely to normal by day 12. Follow-up MRI performed on day 14 showed no pathological findings. This case highlights the importance of early recognition and management of methotrexate-associated PRES in pediatric oncology patients.

Anahtar Kelimeler

• Intrathecal drug administration
• methotrexate
• posterior reversible encephalopathy syndrome
• precursor B-Cell lymphoblastic leukemia-lymphoma

Destekleyen Kurum

Conflict of Interest: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Financial Disclosure: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Etik Beyan

Informed Consent Statement: Written informed consent was obtained from the patient’s legal guardian for publication of this case report and any accompanying images.

Teşekkür

Acknowledgments: None.

Pediatrik Bir Hastada İntratekal Metotreksat (MTX) Tedavisini Takiben Gelişen Posterior Reversibl Ensefalopati Sendromu (PRES): Olgu Sunumu

Öz

Posterior Reversibl Ensefalopati Sendromu (PRES), baş ağrısı, nöbet, görme bozuklukları ve bilinç değişiklikleri ile seyreden, karakteristik manyetik rezonans görüntüleme (MRG) bulguları ile tanımlanan nörolojik bir sendromdur. Bu olguda, intratekal metotreksat tedavisini takiben PRES gelişen 4 yaşında bir erkek çocuğu sunulmaktadır. Hasta, B-hücreli akut lenfoblastik lösemi (B-ALL) tanısıyla tedavi altına alınmış ve indüksiyon tedavisi olarak ALL Protokol-1A protokolüne göre kemoterapi başlanmıştır. İntratekal metotreksat uygulanmasından 48 saat sonra baş ağrısı, fışkırır tarzda kusma şikayetleri başlamış, daha sonra jeneralize tonik-klonik nöbet, ajitasyon ve mekanik ventilasyon ihtiyacı gelişmiştir. Vital bulgularında hipertansiyon saptanmış, beyin MRG’de bilateral parieto-oksipital bölgelerde T2 ve FLAIR sekanslarda hiperintens lezyonlar izlenmiş, difüzyon kısıtlanması izlenmemiştir. PRES tanısıyla antihipertansif, antiödem ve destek tedavileri verilmiştir. Sekizinci günde ekstübe edilmiş, on ikinci günde nörolojik muayenesi tamamen normale dönmüştür. Tanıdan 14 gün sonra çekilen kontrol MRG’de patoloji saptanmamıştır. Bu olgu, pediatrik onkoloji hastalarında metotreksata bağlı gelişebilecek PRES tablosunun erken tanı ve yönetiminin önemini vurgulamaktadır.

Anahtar Kelimeler

• İntratekal ilaç uygulaması
• metotreksat
• posterior reversibl ensefalopati sendromu
• prekürsör B hücreli lenfoblastik lösemi-lenfoma

Kaynakça

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