A Case of Diffuse Leukoencephalopathy Following Low Dose Intravenous Methotrexate Therapy

J Korean Neurol Assoc > Volume 18(1); 2000 > Article

Journal of the Korean Neurological Association 2000;18(1): 77-79.

Methotrexate 저용량 정맥 요법 후 발생된 미만성 백질뇌병증 1예

정필욱, 오경미 ·김한영 ·문소영 ·서대원

성균관대학교 의과대학 삼성의료원 신경과

A Case of Diffuse Leukoencephalopathy Following Low Dose Intravenous Methotrexate Therapy

Pil Wook Chung, M.D., Kyung Mi Oh, M.D., Han-Young Kim, M.D., So Young Moon, M.D., Dae Won Seo, M.D.

Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine

Abstract

Diffuse leukoencephalopathy is a well-known complication of methotrexate in intrathecal or high dose intravenous administration, especially when it is combined with cranial radiation therapy. However, low dose intravenous methotrexate induced leukoencephalopathy has not been reported previously. A 46-year-old female was administered intravenous methotrexate and 5-fluorouracil with oral cyclophosphamide after a modified radical mastectomy for breast cancer. After six cycles of chemotherapy, she developed rapidly progressing dementia and upper motor neuron signs. Brain MRI showed bilaterally symmetric white matter lesion without gadolinium enhancement. Laboratory investiga-tion showed no evidence of brain metastasis. This case suggests that low dose intravenous methotrexate can induce dif-fuse leukoencephalopathy. J Korean Neurol Assoc 18(1):77~79, 2000 Key Words : Leukoencephalopathy, Methotrexate, Breast cancer