Abstract

CASE REPORT ON ACUTE METHOTREXATE TOXICITY

Bonish Romance, Devika Vijay R., S. Jeni Sharon, Dr. Gopal S., Dr. Shajahan O.
M., Dr. Aarthi Prakasam, Dr. N. Babu*

Abstract

Background: Methotrexate is currently considered the first-line disease-modifying antirheumatic drugs (DMARDs). It is an antimetabolite that competitively inhibits the conversion of dihydrofolate to tetrahydrofolate by binding to dihydrofolate reductase. It has been widely and safely used in the treatment of rheumatoid arthritis, psoriasis, and many other rheumatologic diseases. The most common cause of acute MTX toxicity is an accidental overdose of MTX tablets by the patient or physician’s prescription error. Case presentation: This is a case report of a 72 year old female patient who developed rashes all over the body with erythema, urticaria, followed by oral ulcers and bleeding from mouth. A detailed literature review found that pancytopenia, gastrointestinal (GI) mucositis, mouth ulcers and acute renal failure as warning signs of severe methotrexate toxicity. Conclusion: Methotrexate being an option of great therapeutic value for RA, its use should be well guided and counselled by the physician with strict warnings. This case instantiate the importance of recognizing clinical signs of MTX toxicity and to commence therapy as soon as possible. Although low-dose MTX turn up to be a safe medication, acute MTX toxicity can be fatal. So it is important to use this medicine with much precautions by creating awareness about the ill effects of MTX if not taken as instructed, among the patients.

Keywords: Methotrexate, Erythema, Pancytopenia.