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Case Reports
. 2022 Dec 13;14(12):e32494.
doi: 10.7759/cureus.32494. eCollection 2022 Dec.

Low-Dose Methotrexate Toxicity Presenting as Pancytopenia

Gundip S Dhillon  1 , Sukhjinder Chauhan  2 , Yema Jalal  1 , Youssef Ghobrial  1 , Birjees Ahmed  3   4
Affiliations
Case Reports

Low-Dose Methotrexate Toxicity Presenting as Pancytopenia

Gundip S Dhillon et al. Cureus. .

Abstract

High-dose methotrexate (MTX, 5 g/week) is typically used for the treatment of different malignancies and may be associated with serious side effects, such as acute kidney injury, myelosuppression, and hepatotoxicity. On the other hand, low-dose MTX (10-25 mg/week) is considered to be a safe and effective treatment for autoimmune arthropathies. Toxicity due to low-dose MTX is rare but can present with serious complications, such as pancytopenia. In this report, we present the case of an 82-year-old woman who presented with low-dose, MTX-induced severe pancytopenia and was treated with leucovorin rescue therapy with granulocyte colony-stimulating factor (G-CSF) therapy.

Keywords: g-csf; granulocyte colony-stimulating factor; leucovorin; low-dose methotrexate; methotrexate toxicity; pancytopenia secondary to low-dose methotrexate; poison control; sodium bicarbonate.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. CT of the chest demonstrated small bilateral pleural effusions and possible pneumonitis, suggesting MTX toxicity.
CT, computed tomography; MTX, methotrexate
See this image and copyright information in PMC

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