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Background: Posterior reversible encephalopathy syndrome has been attributed to be a major neurological manifestation of intrathecal methotrexate. Here, we present three cases of this syndrome after intrathecal methotrexate, one was male and two were females. All the patients were undergoing treatment for active acute lymphoblastic leukemia. Case reports: Case-1, a five-year-old male, with isolated CNS relapse of pre-B ALL, was administered IT-MTX as part of chemotherapy protocol. Symptoms appeared for which magnetic resonance imaging was done, which was suggestive of PRES. Patient was found hypo calcemic and was managed conservatively. Case-2, an eight-year-old female with pre-B-ALL, developed symptoms after IT-MTX. All the labs were within normal limits so she was also managed conservatively. Case-3, a five-year-old female developed PRES 14 days after administration of IT-MTX. Only hypokalemia was found in laboratory investigations, and was also managed conservatively. Discussion: Although MTX-induced PRES is well documented and may hinder the standard chemotherapy plan, but in all of our patients recovery was uneventful and they were continued with recommended therapeutic plans. Conclusions: Pediatric patients with ALL after IT-MTX are at risk of developing PRES. Symptoms may get resolve by conservative management without discontinuation or delay in chemotherapeutic treatment.

international journal of cancer research and molecular mechanisms

Incidence of Methotrexate induced Posterior Reversible Encephalopathy Syndrome in Pediatric Cancer Patients; A Case Series from a Tertiary Care Hospital, Pakistan