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[Overdose of methotrexate with a fatal outcome in a patient with rheumatoid arthritis]
1Kliniki Reumatologii Instytutu Chorób Wewnetrznych Akademii Medycznej w Poznaniu.
Abstract:
A 52-year old female patient with rheumatoid arthritis (RA) had mistakenly taken 112.5 mg methotrexate (MTX) over a period of five days. As a result, extensive erosions along with necrotic changes occurred in the oral cavity, the groins and vulva mucous membrane. Haemorrhages in the gastrointestinal tract, dermal xanthochromia, interstitial pneumonia and progressive renal insufficiency, as well as hair loss, also followed. Laboratory examination showed peripheral blood agranulocytosis, a decrease in the overall number of blood platelets, anaemia, an increase in the level of transaminases and bilirubin, along with megakaryocyte deficiency. Cultivated dermal specimens initially developed bacteria, then Candida albicans. The patient died on the 22nd day after the overdose from pneumonia and extensive mycosis.
Insights
Methotrexate (MTX) overdose in a rheumatoid arthritis patient caused severe oral, skin, and gastrointestinal issues, leading to fatal pneumonia and mycosis. This case highlights MTX toxicity risks.
Area of Science:
- Toxicology
- Rheumatology
- Pharmacology
Background:
- Rheumatoid arthritis (RA) management often involves methotrexate (MTX).
- MTX is a potent disease-modifying antirheumatic drug (DMARD).
- Accidental overdose can lead to severe adverse events.
Observation:
- A 52-year-old female RA patient mistakenly took 112.5 mg MTX daily for five days.
- Observed extensive oral, groin, and vulvar mucous membrane erosions and necrosis.
- Symptoms included GI hemorrhages, dermal xanthochromia, interstitial pneumonia, renal insufficiency, and hair loss.
Findings:
- Laboratory results revealed agranulocytosis, thrombocytopenia, anemia, elevated transaminases and bilirubin, and megakaryocyte deficiency.
- Dermal cultures initially showed bacterial growth, followed by Candida albicans.
- The patient succumbed to pneumonia and extensive mycosis on day 22 post-overdose.
Implications:
- This case underscores the critical importance of accurate methotrexate dosing.
- Highlights the potential for severe, multi-organ toxicity with MTX overdose.
- Emphasizes the need for prompt recognition and management of MTX toxicity in clinical practice.