Severe Pancytopenia and Stomatitis Case due to the Treatment with High Dose Methotrexate

Abstract

Abstract: Objective: Methotrexate is used to suppress inflammation in many rheumatologic conditions. Here we present an elderly patient who developed serious side effects due to methotrexate. A 78 year old male admitted to emergency department with oral mucosal bleeding, skin rash, decrease in oral nutrition intake and weakness. He had been using 5 milligrams of methotrexate as 2 tablets twice a day for 10 days, after he was diagnosed with psoriatic arthritis 15 days ago. A diagnosis of methotrexate intoxication established with history, physical examination and laboratory analysis, which revealed pancytopenia. His signs and symptoms, as well as pancytopenia were recovered on 6th day of the hospitalization. He had been treated with folinic acid and filgrastim along with supportive care. Although methotrexate treatment and toxicity is well established it is still a clinical challenge that all clinicians must be aware of. In conclusion, methotrexate intoxication is a clinical entity that can lead to serious clinical consequences, and it is essential to diagnose and initiate appropriate treatment without delay to prevent morbidity and mortality. Keywords: Methotrexate toxicity, Pancytopenia, Treatment, Folinic acid, Filgrastim, Inflammation, Psoriatic arthritis.