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Case Reports
. 2013 Nov-Dec;45(6):631-3.
doi: 10.4103/0253-7613.121385.

Pott's disease and hypercalcemia in a patient with rheumatoid arthritis receiving methotrexate monotherapy

Mehmet Zorlu  1 , Muharrem Kiskac  1 , Cumali Karatoprak  1 , Mustafa Cakirca  1 , Erdinç Yavuz  2 , Güven Cetin  1 , Mehmet Ali Cıkrıkçıoğlu  1
Affiliations
Case Reports

Pott's disease and hypercalcemia in a patient with rheumatoid arthritis receiving methotrexate monotherapy

Mehmet Zorlu et al. Indian J Pharmacol. 2013 Nov-Dec.

Abstract

Methotrexate (MTX) may have adverse effects on multiple organs and system. A few cases of pulmonary tuberculosis in-patients with rheumatoid arthritis (RA) while receiving MTX monotherapy has been reported in the literature. We submit a case of vertebral tuberculosis with hypercalcemia in a patient receiving MTX monotherapy. Patient with RA taking MTX for 15 years developed pancytopenia, skin necrosis, tuberculous spondylodiscitis and hypercalcemia. The present case showed adverse effects of MTX therapy may occur even after years of continuous treatment. Due to pancytopenia in older patients, life-threatening tuberculosis at unusual sites may develop.

Keywords: Hypercalcemia; Pott's disease; methotrexate; pancytopenia; rheumatoid arthritis.

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Conflict of interest statement

Conflict of Interest: No

Figures

Figure 1
Figure 1
(a) Granulomatous foci consisting of Langans type giant cells and epithelioid histiocytes located in the bone trabecule and paratrabecular structures on the right [H and E, ×400]; (b) a paratrabecular granulomatous focus in the normocellular bone marrow [H and E, ×200]
Figure 2
Figure 2
Positron emission tomography imaging of the patient showing evidence of inflammation
See this image and copyright information in PMC

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