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Severe Methotrexate toxicity after ectopic pregnancy: a case report managed with continuous renal replacement therapy
Yuting Chao1,2, Qimeng Liu1,2, Aihua Li3,4
1School of Clinical Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, No.6699, Qingdao Road, Huaiyin District, Shandong, 250117, Jinan, China.
Cancer Chemotherapy and Pharmacology
|June 16, 2026
Summary
Severe methotrexate (MTX) toxicity occurred due to a dosing error in ectopic pregnancy treatment. Continuous renal replacement therapy (CRRT) proved effective for MTX removal when glucarpidase was unavailable.
Area of Science:
- Pharmacology
- Nephrology
- Toxicology
Background:
- Methotrexate (MTX) is a vital non-surgical treatment for ectopic pregnancy.
- A narrow therapeutic window for MTX requires precise dosing to avoid toxicity.
- Dosing errors can lead to severe MTX intoxication, particularly with impaired renal function.
Purpose of the Study:
- To report a case of severe MTX intoxication following a dosing error in ectopic pregnancy management.
- To evaluate the efficacy of continuous renal replacement therapy (CRRT) as a salvage treatment for MTX toxicity when glucarpidase is unavailable.
Main Methods:
- A case report of a 31-year-old woman with ectopic pregnancy treated with an excessive intramuscular dose of MTX.
- Management included leucovorin rescue, urine alkalinization, and supportive care.
- CRRT was initiated due to progressive renal dysfunction and impaired MTX clearance.
Main Results:
- The patient experienced severe gastrointestinal symptoms and acute kidney injury (AKI).
- Despite initial treatments, renal dysfunction persisted, hindering MTX clearance.
- CRRT facilitated sustained MTX removal, leading to gradual clinical and biochemical recovery.
Conclusions:
- This case underscores the critical need for meticulous dose verification in MTX administration.
- Continuous renal replacement therapy (CRRT) can be a life-saving salvage option for severe MTX toxicity with acute kidney injury, especially when glucarpidase is not accessible.
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