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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
Summary
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.
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.
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