Hey all,
Sometimes it's nice getting updates on these interesting cases, so figured
I'd follow up with some "answers".
Neuro and the team were identifying MTX as the potential cause for
leukoencephalopathy toxicity, BUT he also had significantly low B12.
Recently I have seen 3 patients all with severe neuro toxicities with B12
deficiencies. This patient went home (against my advice), with hopes he
follows up OP neuro to address some of his deficits. Thanks for everyone's
input! Would love to keep reading some case studies on here.
Shai
On Tue, Jul 19, 2022 at 2:13 PM Shai Sewell <ssewell1989@xxxxxxxxx> wrote:
Good afternoon everyone. Hoping people could shed some insight on a case.
I currently have a 25 y.o. male with a PMHx of ALL with CNS involvement,
currently being treated with ponatinib daily, intrathecal methotrexate via
ommaya reservoir, and periodic IV Vincristine. He is being evaluated for
ataxic gait and paresthesias of the lower extremities. Neuro is relating
the temporal dose of his vincristine (last given on 6/22) and his current
symptoms (which started around 07/04) to his symptoms. He was hypoactive on
his reflexes (both upper and lower) as well (1+). He was cleared from CNS
involvement in March, but I am sure they will retest with an LP with these
symptoms. I don't have much experience with ALL or Vincristine, but these
symptoms seem odd with such a sudden onset. Any thoughts on whether this is
common with Vincristine, something else, or if it is more likely due to
recurrence?
Thanks in advance,
Shai Sewell
