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

Authors : Mustafa Orhan Duyar, Mehmet Akif Dündar, Serra Dağhan, Fatma Türkan Mutlu

Pages : 105-108

Doi:10.55694/jamer.1721532

View : 52 | Download : 145

Publication Date : 2025-12-31

Article Type : Other Papers

Abstract :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.
Keywords : İntratekal ilaç uygulaması, metotreksat, posterior reversibl ensefalopati sendromu, prekürsör B hücreli lenfoblastik lösemi-lenfoma

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