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Acute urticaria and hepatitis complicating high-dose methotrexate therapy
Z al-Lamki1, E Thomas, N el-Banna
1Department of Child Health, College of Medicine, Sultan Qaboos University Hospital, Sultanate of Oman.
Medical and Pediatric Oncology
|February 1, 1995
Summary
High-dose methotrexate, used to prevent lung metastases, caused anaphylaxis and liver issues in a child after 23 courses. A repeat dose led to a similar adverse reaction, indicating a delayed hypersensitivity.
Area of Science:
- Pediatric Oncology
- Clinical Toxicology
- Immunology
Background:
- High-dose methotrexate is a chemotherapy agent utilized in pediatric oncology.
- Methotrexate is often administered as an adjuvant therapy to prevent or treat metastatic disease, particularly in osteosarcoma.
- Prior administrations of methotrexate in this patient were well-tolerated over 22 courses.
Observation:
- An unusual adverse event occurred in a child during the 23rd course of high-dose methotrexate therapy.
- The patient experienced anaphylaxis, a severe allergic reaction, and hepatitic dysfunction, indicating liver injury.
- A subsequent attempt to re-administer methotrexate resulted in a recurrence of similar anaphylactic and hepatitic symptoms.
Findings:
- Delayed hypersensitivity to high-dose methotrexate can manifest after numerous well-tolerated prior exposures.
- Anaphylaxis and hepatitic dysfunction represent potential, albeit rare, adverse effects of cumulative methotrexate exposure.
- The 23rd course of methotrexate triggered an unexpected and severe reaction, suggesting a change in immune response.
Implications:
- Clinicians should be vigilant for rare, delayed hypersensitivity reactions to methotrexate, even after prolonged successful treatment.
- This case highlights the importance of monitoring for anaphylaxis and liver function in pediatric patients receiving high-dose methotrexate.
- Further investigation into the mechanisms of delayed methotrexate hypersensitivity may inform safer treatment protocols.