MARKED IMPROVEMENT OF DELAYED METHOTREXATE-INDUCED LEUKOENCEPHALOPATHY TREATED WITH HIGH-DOSE FOLINIC ACID

We report the case of a patient with delayed methotrexate (MTX)-induce d leukoencephalopathy who showed a marked improvement both in clinical and neuroimaging findings after a high-dose of the active form of fol inic acid (leucovorin) treatment. The patient developed progressive af fective impairment accompanied by headache, nausea and vomiting after treatment with MTX during the chemotherapy for acute lymphoblastic leu kemia, and diagnosed as delayed type MTX-induced leukoencephalopathy. After an intravenous injection of high-dose folinic acid (total 1920 m g), neurological deficits and white matter changes dramatically improv ed in a few weeks. Although delayed MTX-induced leukoencephalopathy ma y cause irreversible brain damage, an early treatment with high dose l eucovorin may thus facilitate the marked improvement of clinical findi ngs and white matter abnormalities.