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Methotrexate induced pancytopenia.

Fernando Gonzalez-Ibarra1, Sahar Eivaz-Mohammadi1, Shiri Surapaneni1

  • 1Department of Internal Medicine, Mount Sinai School of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USA.

Case Reports in Rheumatology
|July 10, 2014
PubMed
Summary
This summary is machine-generated.

Low dose methotrexate (MTX) can cause severe myelosuppression, particularly in the elderly. This case highlights pancytopenia in a 73-year-old woman on daily MTX for rheumatoid arthritis.

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Area of Science:

  • Pharmacology
  • Rheumatology
  • Geriatrics

Background:

  • Methotrexate (MTX) toxicities are dose and duration-dependent.
  • Common MTX side effects include mucositis (early) and myelosuppression/pancytopenia (later).
  • Elderly patients are at increased risk for severe myelosuppression from MTX therapy.

Purpose of the Study:

  • To report a case of severe pancytopenia in an elderly patient receiving low-dose daily methotrexate.
  • To emphasize the potential risks of myelosuppression associated with low-dose MTX in older adults.

Main Methods:

  • Case report presentation.
  • Review of patient's medical history and drug regimen.
  • Clinical assessment of methotrexate toxicity.

Main Results:

  • A 73-year-old female developed pancytopenia, severe neutropenia, and mucocutaneous bleeding.
  • The patient required intravenous antibiotics and blood product transfusions.
  • Symptoms were attributed to daily low-dose methotrexate for rheumatoid arthritis.

Conclusions:

  • Low-dose daily methotrexate can lead to significant myelosuppression, even in the elderly.
  • Close monitoring for hematologic toxicity is crucial in elderly patients on MTX.
  • This case underscores the need for careful risk-benefit assessment in geriatric MTX therapy.