90 Fungal Exit Site Infections (ESI) and Fungal Peritonitis (P) Over a 30 Year Period with and without Exit Site Prophylaxis

INTRATHECAL METHOTREXATE NEPHROTOXICITY Vince Faridani, Jim Mertz University of Missiouri – Kansas City, Kanas City, Missouri, USA We are repor ng a pa ent who presented with acute renal failure secondary to intrathecal methotrexate administra on for treatment of acute lymphoblas c leukemia (ALL). A 47 year-old Hispanic gentleman presented to our hospital complaining of generalized fa gue and lower extremity rash. Laboratory data disclosed a complete blood cell count with a WBC of 1.6, PLT < 61,000, HCT 40.9%, HGB 14.4 g/dl. Serum urea was 14 mg/dl, crea nine .9 mg/dL. Bone marrow biopsy showed a hypercellular bone marrow (90%) and with increased blast cells (nearly 100%) compa ble with ALL. Pa ent received cyclophosphamide, vincris ne, doxorubicin and dexamethasone and intrathecal methotrexate with hydra on and aklaliniza on. The following day, crea nine increased to 2.5mg/dl, serum uric acid level was 10.6 mg/dL, methotrexate level was 23.56 μM, confirming tumor lysis syndrome. He was further treated with intravenous hydra on, alkaliniza on of the urine, and suppor ve therapy with intensive leucovorin for 12 days. This is the 2nd known case report that illustrates a previously unrecognized poten al complica on of intrathecal methotrexate -acute tumor lysis syndrome. If not treated early and aggressively, methotrexate can damage normal cells leading to cell death and resul ng in renal, hepa c, and central nervous system toxicity. As this case illustrates, even with intrathecal methotrexate toxicity, treatment with pharmacologically guided leucovorin rescue along with con nua on of hydra on and alkaliniza on will facilitate restora on of renal func on and decrease the risk of impending systemic toxicity.