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Case Reports
. 2020 Jun 7;12(6):e8492.
doi: 10.7759/cureus.8492.

Pancytopenia as a Complication of Low-Dose Methotrexate in a Septuagenarian: A Rare Presentation

Tejaswi Kanderi  1 , Janet Chan Gomez  1 , Max M Puthenpura  2 , Keerthi Yarlagadda  1 , Mounika Gangireddy  1
Affiliations
Case Reports

Pancytopenia as a Complication of Low-Dose Methotrexate in a Septuagenarian: A Rare Presentation

Tejaswi Kanderi et al. Cureus. .

Abstract

Methotrexate (MTX) is an antimetabolite that was initially developed as a chemotherapeutic agent to treat malignancies but later used extensively to treat rheumatological conditions. MTX-induced toxicity is dose- and duration-dependent. Myelosuppression is a rare but fatal complication of MTX that can occur even with low doses used for inflammatory conditions. Multiple factors such as age, renal impairment, and nutritional status increase the risk of developing MTX toxicity. Frequent monitoring of symptoms and lab values are the hallmarks of prompt diagnosis and prevention of complications. Clinicians should have a high degree of suspicion to diagnose pancytopenia secondary to MTX especially in patients with multiple confounding comorbidities. We present the case of a 79-year-old male who presented with mucositis and pancytopenia diagnosed to be secondary to weekly MTX for giant cell arteritis leading to anemia and septic shock causing death.

Keywords: impaired renal function; leucovorin; methotrexate; pancytopenia.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Trend in hemoglobin
Day 1 is the day of admission. Values marked in black represent the values that prompted blood transfusion.
Figure 2
Figure 2. Trend in white blood cell count
Day 1 is the day of admission.
Figure 3
Figure 3. Trend in platelets
Day 1 is the day of admission. Values marked in black represent the values that prompted platelet transfusion.
See this image and copyright information in PMC

References

    1. Giant cell arteritis: early diagnosis is key. Baig IF, Pascoe AR, Kini A, Lee AG. Eye Brain. 2019;11:1–12. - PMC - PubMed
    1. [Treatment of giant cell arteritis and polymyalgia rheumatica] Horvath L, Hellmich B. Z Rheumatol. 2020;79:175–185. - PubMed
    1. Polymyalgia rheumatica and giant cell arteritis: a systematic review. Buttgereit F, Dejaco C, Matteson EL, Dasgupta B. JAMA. 2016;315:2442–2458. - PubMed
    1. Systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis: focus on giant cell arteritis. Monti S, Agueda AF, Luqmani RA, et al. RMD Open. 2019;5:1003. - PMC - PubMed
    1. Single low-dose methotrexate-induced fatal pancytopenia: case report and review of the literature. Uz B. Biomed J Sci Tech Res. 2019;15:2763.

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