Diffuse Necrotizing Myelitis following Intracystic Bleomycin Chemotherapy for Craniopharyngioma

A child with recurrent adamantinomatous craniopharyngioma was treated with surgery and radiosurgery followed by 12 cycles of intracystic bleomycin injections. One month after treatment, he developed progressive lower extremity paresthesia, pain, wide-based gait, and urinary incontinence. MR imaging showed extensive T2 hyperintensity, enlargement, and enhancement extending from the medulla to the lower thoracic spinal cord. Spinal cord biopsy showed necrotizing myelitis. To our knowledge, this is the first histologically proven case of bleomycin spinal cord neurotoxicity.