MRI SIGNS IN METHOTREXATE-RELATED LEUKOENCEPHALOPATHY IN CHILDREN WITH BURKITT LYMPHOMA-ABDOMINAL MANIFESTATION

Abstract

Burkitt lymphoma, classified as a subtype of non-Hodgkin lymphoma, primarily targets children. It frequently presents with extranodal involvement, often manifesting as an abdominal or pelvic mass upon initial presentation. Treatment regimen commonly incorporates chemotherapy, wherein the prognosis, particularly in pediatric cases, is notably favorable, with survival rates exceeding 90%. However, the utilization of methotrexate, a chemotherapy agent employed in hematological malignancies and other neoplasms, warrants careful consideration due to its propensity for neurotoxicity. Methotrexate-induced neurotoxicity may be presented across a spectrum of acute and chronic leukoencephalopathies. One significant manifestation is toxic encephalopathy, characterized by its predominant affliction of subcortical white matter. Additionally, notable findings include confluent hyperintensities observable on T2 and FLAIR imaging, particularly evident in the centrum semiovale region. Magnetic resonance imaging (MRI) stands as the preferred diagnostic modality. This non-invasive and sophisticated imaging technique holds immense clinical and research utility. Leveraging MRI enables early detection of neurological conditions, facilitates ongoing monitoring of treatment outcomes, and supports timely interventions, thereby offering significant benefits in patient’s care.

We report the case of a 4-years-old patient diagnosed with Burkitt lymphoma, who underwent an MRI scan following symptoms of blindness and convulsions. Initial CT scans showed no discernible pathology. Subsequent MRI findings revealed signal abnormalities, typical of methotrexate-related leukoencephalopathy. Notably, convulsions ensued shortly after initiating methotrexate treatment. These MRI findings are characteristic of toxic encephalopathy, highlighting the importance of vigilant monitoring in patients undergoing methotrexate therapy.