High-Dose Methotrexate-Induced Idiopathic Intracranial Hypertension in Infant Acute Lymphoblastic Leukemia

A 7-month-old female patient with B-cell acute lymphoblastic leukemia (ALL) developed recurring anterior fontanelle bulging after completing both of her first and second courses of high-dose methotrexate (HD-MTX) induction. She did not, however, show any other abnormal neurological examinations, abnormal laboratory investigations, or abnormal brain CT.

She recovered completely with mannitol and dexamethasone treatment. It appears that she benefited from prophylactic dexamethasone since she did not experience neurotoxicity following her third and fourth HD-MTX courses. Our clinical team concluded that the baby girl likely experienced idiopathic intracranial hypertension (IIH) induced by HD-MTX, which is characterized by increased intracranial pressure in the absence of any intracranial space-occupying lesion. Interestingly, we found that prophylactic use of dexamethasone could prevent foreseeable side effects of HD-MTX infusion, which has not been previously reported.

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Article Information: Zhang Y, Qiu Y, Wang Z, Wang R, Jin R, Hinkle LE and Wu X (2020) High-Dose Methotrexate-Induced Idiopathic Intracranial Hypertension in Infant Acute Lymphoblastic Leukemia. Front. Pharmacol. 11:839. doi: 10.3389/fphar.2020.00839