Catatonia in a 13-Year-Old With T-Cell Lymphoblastic Lymphoma Following Intrathecal Methotrexate.
This report describes a 13-year-old with T-cell lymphoblastic lymphoma who developed catatonia five days after intrathecal methotrexate, rapidly improved with lorazepam, and later underwent methotrexate rechallenge with leucovorin without recurrence.
Open original publication →What the AI sees
This report describes a 13-year-old with T-cell lymphoblastic lymphoma who developed catatonia five days after intrathecal methotrexate, rapidly improved with lorazepam, and later underwent methotrexate rechallenge with leucovorin without recurrence.
Research significance
The case supports early recognition and lorazepam-responsive management of catatonia temporally associated with intrathecal methotrexate; it further suggests—but does not establish—that carefully monitored methotrexate rechallenge with leucovorin may be feasible in selected patients.
Source abstract
BACKGROUND: Methotrexate neurotoxicity is a recognized complication in pediatric lymphoid malignancies, presenting with seizures, stroke-like episodes, or leukoencephalopathy. Catatonia is a rare and underrecognized manifestation. OBSERVATION: A 13-year-old girl with T-cell lymphoblastic lymphoma developed agitation, confusion, and catatonia 5 days after intrathecal methotrexate. Investigations excluded structural, infectious, metabolic, and malignant causes. Psychiatry confirmed catatonia (Bush-Francis Catatonia Rating Scale 21-22). Lorazepam led to rapid improvement. Intrathecal methotrexate was later reintroduced with leucovorin rescue without recurrence. CONCLUSIONS: Catatonia may represent an uncommon presentation of methotrexate neurotoxicity. Early recognition and lorazepam treatment are critical, and cautious methotrexate rechallenge may be feasible.