mercaptopurine and Calcinosis

We report a 13-year-old boy with Lennox-Gastaut syndrome (LGS) associated with leukoencephalopathy. He was diagnosed with unclassified acute lymphocytic leukemia at the age of 3 years. After initial chemotherapy, he received intravenous methotrexate (total dosage 1,035 mg), intrathecal methotrexate (total dosage 221 mg), and whole brain irradiation (2,400 cGy). From about the age of 8 years, he developed slurred speech, hyperactivity, and mental deterioration. Cranial CT revealed calcification of the subcortical white matter. At age 9 years, he exhibited tonic seizures and atonic seizures. EEG showed diffuse slow spike-wave discharges, which are characteristic of LGS. Although multiple antiepileptic drugs have been prescribed, the frequency of seizures remains unchanged and his mental state is becoming progressively worse.

Topics: Adolescent; Anticonvulsants; Antineoplastic Combined Chemotherapy Protocols; Brain Damage, Chronic; Calcinosis; Cranial Irradiation; Cytarabine; Dementia; Doxorubicin; Electroencephalography; Epilepsy, Absence; Epilepsy, Generalized; Humans; Injections, Spinal; Male; Mercaptopurine; Methotrexate; Movement Disorders; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisolone; Radiation Injuries; Syndrome; Vincristine

Calcification occurring in the basal ganglia in children with acute lymphocyte leukemia following therapy is uncommon and to the best of our knowledge has not been reported prior to therapy. Eleven cases of bilateral symmetrical calcification in the basal ganglia were noted in 2350 CT scans, two being in children with acute lymphocytic leukemia. In one of the two cases, calcification was present prior to therapy.

Topics: Basal Ganglia Diseases; Calcinosis; Child; Child, Preschool; Drug Therapy, Combination; Humans; Leukemia, Lymphoid; Male; Mercaptopurine; Methotrexate; Prednisone; Tomography, X-Ray Computed; Vincristine

Topics: Adolescent; Adrenocorticotropic Hormone; Alpha-Globulins; Antibodies, Antinuclear; Antimetabolites; Azathioprine; Blood Protein Electrophoresis; Calcinosis; Child; Creatine; Dermatomyositis; Electromyography; Exercise Therapy; Female; Fluorescent Antibody Technique; Fructose-Bisphosphate Aldolase; Growth Disorders; Humans; Immunosuppression Therapy; L-Lactate Dehydrogenase; Male; Mercaptopurine; Methotrexate; Middle Aged; Muscles; Prednisone; Remission, Spontaneous; Staphylococcal Infections; Transaminases

Topics: Angiography; Calcinosis; Choriocarcinoma; Female; Lung Neoplasms; Mercaptopurine; Methotrexate; Neoplasm Metastasis; Pregnancy