Progressive motor polyradiculopathy and myelopathy associated with lymphoma and intrathecal methotrexate treatment, a case report and systemic review

We report a patient with Burkitt’s lymphoma involving the liver and retroperitoneal lymph nodes who developed acute, progressive, quadriplegia associated with sphincter dysfunctions and an ascending sensory level after the 2 dose of intrathecal methotrexate. The motor deficits and the spinal dysfunction persisted in spite of discontinuation of the methotrexate, as well as treatments with intrathecal steroids, pulse intravenous steroids, and intravenous immunoglobulin. The status of the lymphoma was improving on systemic chemotherapy. Whether the progressive motor neuropathy and progressive myelopathy are a toxicity of intrathecal methotrexate or a paraneoplastic phenomenon is a matter of debate.