Acute Disseminated Myelitis Associated with 5-Fluorouracil and <i>l</i>-Leucovorin Treatment

for jaw jerk. The Babinski refl exes were bilaterally positive. He needed a urinary catheter due to urinary retention problems. Routine laboratory examination was normal except for an erythrocyte sedimentation rate of 17 mm in 1 h. Both HIV and HTLV-1 serum antibodies were negative. Tumor markers, such as CEA and CA19-9, were in the normal range. Cerebrospinal fl uid examination showed the increased cell count of 42 cells/ l and elevated protein of 61 mg/dl. The IgG index was at the upper limit of the normal range at 0.7, suggesting that intrathecal synthesis of IgG did not increase signifi cantly. Myelin basic protein was increased at 489 pg/ml. All bacterial, fungal, and viral cultures were negative. Repeated cytology was negative. Genotyping for HLA showed that he had DRB1*1501 and DQB1*0602. MRI of the spine revealed multiple hyperintense lesions throughout C 3–5 , T 2–3 , 9–12 and conus medullaris on T 2 weighted images ( fi g. 1 ). Those lesions mostly exhibited multiple enhancements after intravenous administration of gadolinium. Only a small hyperintense lesion was seen in the brain white matter without gadolinium enhancement ( fi g. 2 ). The patient was intravenously given methylprednisolone, 1,000 mg/day for 3 days, followed by prednisolone orally, 50 mg/day. The dose was tapered off over 4 Dear Sir, Multifocal infl ammatory leukoencephalopathy (MIL), a central nervous system disorder characterized by demyelination with perivascular infl ammation, has recently been reported in several patients treated with the combination of fl uorouracil (FU) and levamisole chemotherapy [1–9] . However, there have been no reports mentioning spinal lesions, whereas demyelinating lesions have been frequently found in other diseases such as multiple sclerosis (MS), acute transverse myelitis, and acute disseminated encephalomyelitis. We report the fi rst case of a patient with acute disseminated encephalomyelitis associated with 5-FU and l -leucovorin treatment and discuss its putative pathogenesis.