{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:37:23Z","timestamp":1760150243748,"version":"build-2065373602"},"reference-count":16,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2023,10,30]],"date-time":"2023-10-30T00:00:00Z","timestamp":1698624000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Research Funding of Korea (NRF)","award":["2022R1I1A3071887"],"award-info":[{"award-number":["2022R1I1A3071887"]}]},{"name":"Ministry of Education","award":["2022R1I1A3071887"],"award-info":[{"award-number":["2022R1I1A3071887"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Methotrexate (MTX) is commonly used in intrathecal chemotherapy for patients with acute lymphocytic leukemia (ALL) to prevent central nervous system (CNS) involvement. However, the use of MTX-based chemotherapy can lead to rare yet severe complications, such as MTX-induced myelopathy. Here, we report the case of MTX-induced myelopathy initially misdiagnosed as Guillain\u2013Barre syndrome, leading to a delay in diagnosis and treatment. We present a case of a 39-year-old male with a history of B-cell acute lymphoblastic leukemia (B-ALL) who experienced bilateral foot paresthesia and progressive lower extremity weakness after intrathecal methotrexate (MTX) treatment. Initially, the patient was suspected as having Guillain\u2013Barre syndrome (GBS) due to similar clinical features and nerve conduction studies. The patient received intravenous immunoglobulin (IVIG) treatment, but his condition worsened. T2-weighted images of the thoracic spinal cord revealed high signal intensity in both lateral and posterior columns, typically associated with subacute combined degeneration. However, elevated vitamin B12 levels ruled out SCD in this case. Based on the aforementioned findings, intrathecal methotrexate-induced myelopathy was diagnosed. This case highlights the diagnostic challenge posed by the similarity in clinical presentation between MTX-induced myelopathy and GBS. Differentiating between these conditions is critical for appropriate management. Prompt recognition and treatment with folate metabolism compounds may mitigate neurological sequelae.<\/jats:p>","DOI":"10.3390\/diagnostics13213337","type":"journal-article","created":{"date-parts":[[2023,10,30]],"date-time":"2023-10-30T13:00:49Z","timestamp":1698670849000},"page":"3337","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Progressive Lower Extremity Paralysis Caused by Intrathecal MTX-Induced Myelopathy Mimicking Guillain\u2013Barre Syndrome: A Case Report"],"prefix":"10.3390","volume":"13","author":[{"given":"Eun Chae","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4787-4448","authenticated-orcid":false,"given":"Dong Gyu","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1016\/j.mayocp.2016.09.010","article-title":"Adult Acute Lymphoblastic Leukemia","volume":"91","author":"Paul","year":"2016","journal-title":"Mayo Clin. Proc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1016\/S0022-3476(73)80533-5","article-title":"Paraplegia following intrathecal methotrexate","volume":"83","author":"Luddy","year":"1973","journal-title":"J. Pediatr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1097\/01.mph.0000162527.85024.e9","article-title":"Myelopathy due to intrathecal chemotherapy: Report of six cases","volume":"27","author":"Bay","year":"2005","journal-title":"J. Pediatr. Hematol. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S21","DOI":"10.1002\/ana.410270707","article-title":"Assessment of current diagnostic criteria for Guillain-Barre syndrome","volume":"27","author":"Asbury","year":"1990","journal-title":"Ann. Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1002\/ana.410230407","article-title":"Motor conduction studies in Guillain-Barre syndrome: Description and prognostic value","volume":"23","author":"Cornblath","year":"1988","journal-title":"Ann. Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1002\/mus.25242","article-title":"Paraparetic Guillain-Barre syndrome: Nondemyelinating reversible conduction failure restricted to the lower limbs","volume":"55","author":"Kimachi","year":"2017","journal-title":"Muscle Nerve"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1080\/088800101300312618","article-title":"Guillain-Barre syndrome in a child with acute lymphoblastic leukemia","volume":"18","author":"Aral","year":"2001","journal-title":"Pediatr. Hematol. 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Assoc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1007\/s11060-015-1727-z","article-title":"Myelopathy following intrathecal chemotherapy in adults: A single institution experience","volume":"122","author":"Cachia","year":"2015","journal-title":"J. Neuro-Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.pediatrneurol.2014.01.048","article-title":"Review of dextromethorphan administration in 18 patients with subacute methotrexate central nervous system toxicity","volume":"50","author":"Afshar","year":"2014","journal-title":"Pediatr. Neurol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1080\/08880010290057336","article-title":"Dextromethorphan is effective in the treatment of subacute methotrexate neurotoxicity","volume":"19","author":"Drachtman","year":"2002","journal-title":"Pediatr. Hematol. Oncol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/21\/3337\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:14:00Z","timestamp":1760130840000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/21\/3337"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,30]]},"references-count":16,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2023,11]]}},"alternative-id":["diagnostics13213337"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13213337","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2023,10,30]]}}}