[Case of disseminated necrotizing leukoencephalopathy following intrathecal methotrexate in acute lymphocytic leukemia]

Abstract

Disseminated necrotizing leukoencephalopathy was found upon autopsy of a 32-year-old man with acute lymphocytic leukemia. He had been treated with intrathecal methotrexate for CNS involvement; no radiation therapy had been given. Autopsy findings revealed that in the white matter of the temporal lobe, there was widespread necrosis associated with numerous foam cells, demyelination, vacuolization and slight gliosis; in this lesion, leukemic cells infiltrated the Virchow-Robin space. In the white matter of other lesions we found discrete multifocal necroses of coagulative type associated with round or rod-shaped axonal swelling partly accompanied with calcification. However, in these lesions, there was no leukemic cell infiltration.