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Case report demonstrates reversible catatonia following intrathecal methotrexate in a pediatric lymphoma patient, indicating successful lorazepam treatment and feasible drug rechallenge.
BACKGROUND: Methotrexate neurotoxicity is a recognized complication in pediatric lymphoid malignancies, presenting with seizures, stroke-like episodes, or leukoencephalopathy. Catatonia is a rare and underrecognized manifestation. OBSERVATION: A 13-year-old girl with T-cell lymphoblastic lymphoma developed agitation, confusion, and catatonia 5 days after intrathecal methotrexate. Investigations excluded structural, infectious, metabolic, and malignant causes. Psychiatry confirmed catatonia (Bush-Francis Catatonia Rating Scale 21-22). Lorazepam led to rapid improvement. Intrathecal methotrexate was later reintroduced with leucovorin rescue without recurrence. CONCLUSIONS: Catatonia may represent an uncommon presentation of methotrexate neurotoxicity. Early recognition and lorazepam treatment are critical, and cautious methotrexate rechallenge may be feasible.
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Lazarowitz et al. (2026) studied this question.
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