METHOTREXATE TOXICITY AS MYELOSUPPRESSION IN 66-YEAR-OLD FEMALE WITH RHEUMATOID ARTHRITIS IN CHENNAI, TAMIL NADU, INDIA

Manimekalai Periyasamy, Arvindh Manohar

Abstract


Methotrexate can cause a range of toxicities. It is usually not life threatening in low dose even when taken for long term. Life threatening complications are usually seen in high dose methotrexate therapy which could even lead to malignancies. Life threatening complications and adverse effects can be seen at any dose except for nephrotoxicity which is most commonly seen in high dose methotrexate treatment. This case report deals with a case of rheumatoid arthritis on long term methotrexate therapy, who unknowingly took excessive dosage of methotrexate leading to myelosuppression. Patient was treated with folinic acid (leucovorin) rescue, G-CSF and a prolonged isolation following which patient improved. 


Keywords


Methotrexate; Leucovorin; Folinic Acid; G-CSF.

Full Text:

PDF

References


Van Ede A, Laan R, Rood M, Huizinga T, Van De Laar M, Denderen C, et al. Effect of folic or folinic acid supplementation on the toxicity and efficacy of methotrexate in rheumatoid arthritis: A forty-eight-week, multicenter, randomized, double-blind, placebo-controlled study. Arthritis Rheum 2001;44(7):1515-24. https://doi.org/10.1002/1529-0131(200107)44:7<1515::AID-ART273>3.0.CO;2-7

Morgan S, Baggott J, Vaughn W, Young P, Austin J, Krumdieck C, et al. The effect of folic acid supplementation on the toxicity of low-dose methotrexate in patients with rheumatoid arthritis. Arthritis Rheum 1990;33(1):9-18. https://doi.org/10.1002/art.1780330102

Gutierrez-Ureña S, Molina J, García C, Cuéllar M, Espinoza L. Pancytopenia secondary to methotrexate therapy in rheumatoid arthritis. Arthritis Rheum 1996;39(2):272-6. https://doi.org/10.1002/art.1780390214

Krathen M, Gottlieb A, Mease P. Pharmacologic immunomodulation and cutaneous malignancy in rheumatoid arthritis, psoriasis, and psoriatic arthritis. J Rheumatol 2010 Nov;37(11):2205-15. https://doi.org/10.3899/jrheum.100041

Cerminara Z, Duffy A, Nishioka J, Trovato J, Gilmore S. A single center retrospective analysis of a protocol for high-dose methotrexate and leucovorin rescue administration. J Oncol Pharm Pract 2019 Jan;25(1):76-84. https://doi.org/10.1177/1078155217729744




DOI: https://doi.org/10.46903/gjms/20.02.1123

Refbacks

  • There are currently no refbacks.


Copyright (c) 2022. Manimekalai Periyasamy, Arvindh Manohar.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Gomal Medical College, Daraban Road, Dera Ismail Khan, Pakistan

ISSN: 1819-7973, e-ISSN: 1997-2067

Website: https://www.gmcdikhan.edu.pk

Phone: +92-966-747373

Scimago Journal & Country Rank