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A Case of Pancytopenia Secondary to Low-Dose Pulse Methotrexate Therapy in a Patient with Rheumatoid Arthritis and Renal Insufficiency

Most reports on serious MTX toxicity have focused on hepatic abnormalities, while other effects, including hematologic reactions, have not been emphasized. We experienced a case of pancytopenia secondary to MTX therapy in a patient with RA and renal insufficiency. A 67-year-old woman with a 12-year...

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Autores principales: Park, Geun Tae, Jeon, Dae Won, Roh, Kwang Ho, Mun, Hee Sig, Lee, Chang Hwa, Park, Chan Hyun, Kang, Kyeng Won, Kim, Sang Mok, Kang, Jong Myeng, Park, Han Chul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Association of Internal Medicine 1999
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531911/
https://www.ncbi.nlm.nih.gov/pubmed/10063319
http://dx.doi.org/10.3904/kjim.1999.14.1.85
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author Park, Geun Tae
Jeon, Dae Won
Roh, Kwang Ho
Mun, Hee Sig
Lee, Chang Hwa
Park, Chan Hyun
Kang, Kyeng Won
Kim, Sang Mok
Kang, Jong Myeng
Park, Han Chul
author_facet Park, Geun Tae
Jeon, Dae Won
Roh, Kwang Ho
Mun, Hee Sig
Lee, Chang Hwa
Park, Chan Hyun
Kang, Kyeng Won
Kim, Sang Mok
Kang, Jong Myeng
Park, Han Chul
author_sort Park, Geun Tae
collection PubMed
description Most reports on serious MTX toxicity have focused on hepatic abnormalities, while other effects, including hematologic reactions, have not been emphasized. We experienced a case of pancytopenia secondary to MTX therapy in a patient with RA and renal insufficiency. A 67-year-old woman with a 12-year history of active seropositive RA that was a response to non-steroidal anti-inflammatory drugs, hydroxychloroquinine and intra-articular steroid injections, had been followed up and was diagnosed as early chronic renal failure in October, 1993. Recently, because of significant morning stiffness and polyarthralgia, the decision was made to institute MTX treatment. This was begun as a single oral dose of 5mg/week. After 2 doses, the patient was admitted to the hospital with general weakness. Laboratory tests showed a hemoglobin level of 7.9 g/dl, WBC count 1800/mm(3) and platelet count of 64000/mm(3). The serum creatinine level was 6.1 mEq/dl and the BUN level was 82 mEq/dl. Liver function test results were normal, but the serum albumin level was 2.7 g/dl. The patient subsequently developed fever and blood transfusions, granulocyte colony stimulating factor(G-CSF) and intravenous prophylactic antibiotic therapy were required. Her condition was improved. In summary, Low-dose MTX-related adverse hematologic side effects, including fatal pancytopenia, are rare but are a cause of increasing concern in patients with RA and renal insufficiency. Close monitoring of associated risk factors, particulary impaired renal function, should be mandatory for all patients who are receiving MTX therapy.
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spelling pubmed-45319112015-10-02 A Case of Pancytopenia Secondary to Low-Dose Pulse Methotrexate Therapy in a Patient with Rheumatoid Arthritis and Renal Insufficiency Park, Geun Tae Jeon, Dae Won Roh, Kwang Ho Mun, Hee Sig Lee, Chang Hwa Park, Chan Hyun Kang, Kyeng Won Kim, Sang Mok Kang, Jong Myeng Park, Han Chul Korean J Intern Med Case Report Most reports on serious MTX toxicity have focused on hepatic abnormalities, while other effects, including hematologic reactions, have not been emphasized. We experienced a case of pancytopenia secondary to MTX therapy in a patient with RA and renal insufficiency. A 67-year-old woman with a 12-year history of active seropositive RA that was a response to non-steroidal anti-inflammatory drugs, hydroxychloroquinine and intra-articular steroid injections, had been followed up and was diagnosed as early chronic renal failure in October, 1993. Recently, because of significant morning stiffness and polyarthralgia, the decision was made to institute MTX treatment. This was begun as a single oral dose of 5mg/week. After 2 doses, the patient was admitted to the hospital with general weakness. Laboratory tests showed a hemoglobin level of 7.9 g/dl, WBC count 1800/mm(3) and platelet count of 64000/mm(3). The serum creatinine level was 6.1 mEq/dl and the BUN level was 82 mEq/dl. Liver function test results were normal, but the serum albumin level was 2.7 g/dl. The patient subsequently developed fever and blood transfusions, granulocyte colony stimulating factor(G-CSF) and intravenous prophylactic antibiotic therapy were required. Her condition was improved. In summary, Low-dose MTX-related adverse hematologic side effects, including fatal pancytopenia, are rare but are a cause of increasing concern in patients with RA and renal insufficiency. Close monitoring of associated risk factors, particulary impaired renal function, should be mandatory for all patients who are receiving MTX therapy. Korean Association of Internal Medicine 1999-01 /pmc/articles/PMC4531911/ /pubmed/10063319 http://dx.doi.org/10.3904/kjim.1999.14.1.85 Text en Copyright © 1999 The Korean Association of Internal Medicine This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Park, Geun Tae
Jeon, Dae Won
Roh, Kwang Ho
Mun, Hee Sig
Lee, Chang Hwa
Park, Chan Hyun
Kang, Kyeng Won
Kim, Sang Mok
Kang, Jong Myeng
Park, Han Chul
A Case of Pancytopenia Secondary to Low-Dose Pulse Methotrexate Therapy in a Patient with Rheumatoid Arthritis and Renal Insufficiency
title A Case of Pancytopenia Secondary to Low-Dose Pulse Methotrexate Therapy in a Patient with Rheumatoid Arthritis and Renal Insufficiency
title_full A Case of Pancytopenia Secondary to Low-Dose Pulse Methotrexate Therapy in a Patient with Rheumatoid Arthritis and Renal Insufficiency
title_fullStr A Case of Pancytopenia Secondary to Low-Dose Pulse Methotrexate Therapy in a Patient with Rheumatoid Arthritis and Renal Insufficiency
title_full_unstemmed A Case of Pancytopenia Secondary to Low-Dose Pulse Methotrexate Therapy in a Patient with Rheumatoid Arthritis and Renal Insufficiency
title_short A Case of Pancytopenia Secondary to Low-Dose Pulse Methotrexate Therapy in a Patient with Rheumatoid Arthritis and Renal Insufficiency
title_sort case of pancytopenia secondary to low-dose pulse methotrexate therapy in a patient with rheumatoid arthritis and renal insufficiency
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531911/
https://www.ncbi.nlm.nih.gov/pubmed/10063319
http://dx.doi.org/10.3904/kjim.1999.14.1.85
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