ABSTRACT

Introduction: Acute lymphoblastic leukaemia (ALL) is a prevalent paediatric malignancy treated with multi-agent chemotherapy, including high-dose methotrexate. Although effective, methotrexate poses risks such as gastrointestinal toxicity, neurotoxicity, and potential central nervous system (CNS) relapse. Case Presentation: A 12-year-old male with Pre-B ALL and poor response to Prednisolone was admitted after developing a severe headache during chemotherapy. CNS involvement was confirmed via cerebrospinal fluid analysis, leading to a diagnosis of CNS relapse. Despite intensive treatment including intrathecal chemotherapy and supportive care, the patient’s conditiondeteriorated, exhibiting gastrointestinal and neurological complications. The treatment plan included ongoing CNS prophylaxis and management of methotrexate toxicity with Leucovorin. Conclusion: This case underscores the critical balance between the efficacy and toxicity of methotrexate in treating paediatric ALL, highlighting the need for vigilant monitoring and management to prevent severe complications such as CNS relapse. Keywords: Acute lymphoblastic leukaemia, methotrexate, central nervous system relapse, paediatric oncology, chemotherapy toxicity
Publication date: 01/05/2026

https://www.ijbpas.com/pdf/2026/May/MS_IJBPAS_2026_10177.pdf

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https://doi.org/10.31032/IJBPAS/2026/15.5.10177