Meningopatia leucémica em paciente com remissão hematológica tratado com sucesso pelo Amethopterin Intratecal

Abstract

The case of a 3-year old boy affected by acute leukemia and presenting a picture of meningeal involvement is discussed. The neurological ma- nifestations occurred after a period of 18 months of clinical and hematological remission. The symptoms were those of intracranial hypertension; presence of numerous leukemic cells in the cerebrospinal fluid and widening of cranial sutures were observed. A two months course of treatment with intrathecal injection of 5 mg Amethopterin each brought about an excellent neurological recovery that is lasting for more than 4 months. The injections were made firstly at a five day interval, which was increased at the end of the treatment. The experience of this case added to those of prior cases documented in the literature stresses the importance of the problem. It is suggested that every case of leukemia be thoroughly examined and if symptoms and signs of neurological involvement were found, cerebrospinal fluid examination must be performed. Thus acting it will be possible to diagnose nervous system involvement and start the treatment at earlier stages. In this way the patient may have a better and longer life. The graph clearly shows the importance of cerebrospinal fluid examinations to evaluate the results of the treatment.

É apresentado um caso de meningopatia leucêmica com um quadro de hipertensão intracraniana, que surgiu 18 meses após a remissão clínica e hematológica de leucemia aguda. A terapêutica por via intratecal com o Amethopterin, na dose de 5 mg, repetida 6 vêzes e com intervalos de 5 a 7 dias, proporcionou melhora clínica imediata e normalização do LCR após dois meses de tratamento. O paciente continuou bem clinicamente e com o sangue e o LCR normais após 4 meses de observação. A experiência dêste caso e daqueles citados na literatura justificam que todos os pacientes leucêmicos sejam cuidadosamente observados a fim de se poder diagnosticar precocemente uma complicação neurológica, para que o tratamento adequado possa permitir maior sobrevida. O exame do LCR tem importância decisiva no diagnóstico desta complicação; ulteriormente, os exames seriados do LCR orientam a duração e a intensidade do tratamento. A padronização do tratamento das complicações neurológicas das leucemias constitui campo aberto às investigações.