Reactions 1474, p15-16 - 19 Oct 2013

SCytarabine/hydrocortisonehemisuccinate/methotrexate

Myelopathy following intrathecal administration:case report

A 45-year-old woman developed myelopathy after anintrathecal injection of cytarabine, hydrocortisonehemisuccinate, and methotrexate.

The woman, who was being treated for acute myeloidleukaemia, had previously received her first cycle of inductionchemotherapy with daunorubicin, cytarabine, alkalinehydration and allopurinol. She developed hyperleukocytosisand received a single intrathecal injection, administered over3 minutes to prevent neuromeningeal complications, whichcontained cytarabine 30mg, hydrocortisone hemisuccinate15mg and methotrexate 15mg. She presented with paraplegia3 days later. On examination, she had flaccid paralysis of herlower limbs but no sensory impairment nor sphincterproblems. Pluriradicular damage was seen on anelectromyogram. Oedema formation affecting the lumbarbone marrow, lower back and conus medullaris, was identifiedon a medullary MRI scan. She was diagnosed with myelopathy.

The woman was treated with methylprednisolone but herneurological symptoms did not improve. She underwent asecond course of chemotherapy treatment 4 weeks after herfirst chemotherapy cycle. She died 10 days later as a result ofseptic shock from a multi-resistant gram-negative bacilliinfection.

Author comment: We concluded a diagnosis ofmyelopathy caused by the intrathecal chemotherapyinjection.Nafil H, et al. Paraplegia after the first intrathecal injection of chemotherapy in apatient with acute myeloblastic leukemia. Therapie 67: 533-5, No. 6, Nov-Dec2012. Available from: URL: http://dx.doi.org/10.2515/therapie/2012069 [French;summarised from a translation] - Morocco 803094568

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Reactions 19 Oct 2013 No. 14740114-9954/13/1474-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved