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Leukemoid reaction after methotrexate-induced pancytopenia in a patient undergoing continuous ambulatory peritoneal
Chiao-Ying Sun1, Hou-Chang Lin, Yung-Chih Chen
1Division of Nephrology, Chang Gung Memorial Hospital. 222, Maijin Rd., Anle Chiu, Keelung, Taiwan 204, ROC.
Abstract:
Methotrexate has been used as an important alternative therapy in the treatment of various rheumatic diseases. Life threatening marrow suppression in end-stage renal disease patients undergoing hemodialysis or continuous ambulatory peritoneal dialysis has been reported. A 33-year-old woman with systemic lupus erythematosus undergoing chronic peritoneal dialysis developed severe mucositis and pancytopenia after low-dose methotrexate treatment for arthritis. The leukocyte count recovered after methotrexate was withdrawn but a leukemoid blood picture developed during her recovery. No evidence of leukemia was found on bone marrow biopsy. The leukocyte count gradually returned to normal with conservative therapy.
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