Case of neuromyelitis otica: bilateral sensorineural hearing loss and transverse myelopathy following intrathecal chemotherapy

Abstract

Neurotoxicity from intrathecally administered chemotherapeutic drugs is frequent, particularly with some agents like methotrexate, which are more prone to developing adverse effects. Myelopathy ranks among the most frequently reported neurological entities; with the diagnosis being straightforward, after ruling out infectious, metabolic, autoimmune or paraneoplastic causes. Scarcity of cases precludes evidence-based recommendations for the management of these complications. The most common therapeutic approach consists of the suspension of chemotherapy, exclusion of infectious and neoplastic causes, with prompt administration of high-dose steroids. We report a 21-year-old patient with acute lymphoblastic leukaemia, who developed acute transverse myelitis and bilateral sensorineural hearing loss, after five rounds of intrathecal methotrexate and cytarabine. Although neurotoxicity from both agents has been documented, this combination has not been previously reported.

Longitudinal Extensive Transverse Myelitis in a Four-Year-Old Boy Liver Transplant Recipient

“…Intrathecal methotrexate is widely used and there are a few reports in literature about association of ATM and intrathecal methotrexate. 5 However, the current patient had received three doses previously and the weakness developed after thirteen days of the third dose. Furthermore, he was given a fourth dose without worsening of his neuro status.…”