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PubMed · 9174236

Intrathecal methotrexate overdose.

A C Lee·K W Wong·K W Fong·K T So
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Abstract

We report two cases of intrathecal methotrexate overdose. A 3-y-old girl with acute lymphoblastic leukaemia and a 4-y-old boy with Burkitt's lymphoma were to receive an intrathecal injection of methotrexate after completion of intravenous methotrexate infusion. Instead of 12.5 mg, they both received a dose of 125 mg. Both children developed generalized convulsion 3 h after the overdose, but afterwards recovered completely. Intravenous folinic acid and dexamethasone rescue were employed, but no attempt was made to exchange the cerebrospinal fluid. In addition to the staff's failure to check the drug label carefully, the marked resemblance of the two dose preparations of methotrexate (50 mg/5 ml and 500 mg/5 ml) may have been contributory.

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Antimetabolites, AntineoplasticBurkitt LymphomaChild, PreschoolDrug OverdoseFemaleHumansInjections, SpinalMaleMedication ErrorsMethotrexatePrecursor Cell Lymphoblastic Leukemia-LymphomaSeizuresTime FactorsCase ReportsJournal ArticleReview

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BibTeXRIS

A C Lee, K W Wong, K W Fong, K T So. 1997. Intrathecal methotrexate overdose.. https://doi.org/10.1111/j.1651-2227.1997.tb09039.x

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Neurotoxicity of methotrexate is a well-documented issue, but development of an intracerebral hematoma following administration of intrathecal methotrexate is an extremely rare entity. A 6-year-old male with the diagnosis of non-Hodgkin lymphoma was put on a treatment regimen, including intrathecal methotrexate. Six days following the last intrathecal methotrexate administration, the patient developed a deteriorating state of consciousness. There was no history of trauma. Coagulation studies and platelet count were normal. Magnetic resonance imaging of the brain demonstrated a large left frontoparietal hematoma. Intracerebral hematoma may be a very rare, but serious, complication of intrathecal methotrexate administration.

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