Methotrexate-induced toxidermia and pancytopenia in a patient with ectopic pregnancy: a case report

Abstract Background Methotrexate is an anticancer drug from the antimetabolite class. It is also used in gynecology and obstetrics and is the molecule of choice for the medical treatment of ectopic pregnancies. We report a case of toxidermia associated with severe pancytopenia induced by methotrexate for ectopic pregnancy. Case presentation A 30-year-old Malagasy (African) woman was admitted to the Emergency and Intensive Care Department for probable toxidermia following injection of 75 mg of methotrexate for an ectopic pregnancy. She had developed generalized erythema, which started 48 hours after the injection. The secondary onset of phlyctenular maculopapular skin lesions, generalized purpura, and erosions of the oral mucosa in a context of febrile jaundice prompted her hospitalization. On admission, the patient presented with febrile neutropenia, pancytopenia, renal failure, and hepatic cytolysis. She received transfusions of fresh whole blood, erythromycin, and amphotericin B. The course was fatal within 2 days of hospitalization. The patient died of multiple organ failure. Conclusions Our case is mainly distinguished by the lack of use of granulocyte growth factors and folinic acid. In the event of severe reactions to methotrexate, the management should be multidisciplinary and as much as possible within an intensive care unit.

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Levonorgestrel intrauterine system embedded within tubal ectopic pregnancy: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02723-7 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Dorothy Makena ◽

Ingrid Gichere ◽

Khadija Warfa

Keyword(s):

Case Report ◽

Ectopic Pregnancy ◽

Fallopian Tube ◽

Intrauterine Device ◽

African Woman ◽

Rare Occurrence ◽

Intrauterine Pregnancy ◽

Case Presentation ◽

Tubal Ectopic Pregnancy ◽

Left Fallopian Tube

Abstract Background The presence of the levonorgestrel-releasing intrauterine system embedded within an ectopic pregnancy is a rare occurrence. Tubal migration of an intrauterine device is not well understood and has not been extensively studied in literature. Case presentation A 34-year-old African woman, para 1, gravida 2, presented with symptoms of ruptured ectopic pregnancy. She underwent a laparoscopy where a ruptured left ectopic pregnancy was found with a levonorgestrel-releasing intrauterine system inserted 2 years prior embedded within the tube. A left salpingectomy was performed with removal of the levonorgestrel-releasing intrauterine system. The patient recovered well and proceeded to have an intrauterine pregnancy 3 months later. Conclusion Migration of the levonorgestrel-releasing intrauterine system into the fallopian tube is a rare occurrence that is not well understood. In the case presented, levonorgestrel-releasing intrauterine system was found embedded within the fimbrial end of the left fallopian tube, which had a ruptured ectopic pregnancy. Surgical treatment with laparoscopy is recommended for intraabdominal intrauterine device to prevent complications.

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Secondary abdominal appendicular pregnancy: Case report

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1408484r ◽

2014 ◽

Vol 142 (7-8) ◽

pp. 484-487

Author(s):

Mico Rosso ◽

Sinisa Sijanovic ◽

Zlatko Topolovec ◽

Domagoj Vidosavljevic ◽

Robert Selthofer ◽

...

Keyword(s):

Case Report ◽

Ectopic Pregnancy ◽

Point Of View ◽

Reproductive Age ◽

Gynecology And Obstetrics ◽

Secondary Implantation ◽

Pouch Of Douglas ◽

Histopathologic Analysis ◽

Ectopic Pregnancies ◽

The Right

Introduction. The case report describes a 29-year-old nulliparous woman that was admitted at the Department of Gynecology and Obstetrics of the Clinical Hospital Osijek complaining of mild abdominal pain without vaginal discharge. Case Outline. The patient?s menstrual cycle was irregular, from 30-45 days. An ultrasound examination showed suspicion of an ectopic pregnancy with a ?HCG level of 1358 IU/L. Due to the presence of liquid in the pouch of Douglas the patient underwent emergency laparoscopy, which showed the presence of tumor mass between the right Fallopian tube and the appendix. These two structures associated with adhesions corresponded to secondary implantation after spontaneous tubal abortion which was confirmed by histopathologic analysis. Conclusion. Laparoscopy has emerged as the ?gold standard? in the diagnosis and treatment of ectopic pregnancy, in this case the secondary abdominal pregnancy. From the diagnostic point of view, all women of reproductive age should be considered pregnant until proven otherwise, also keeping in mind that ectopic pregnancies can have different locations and many clinical features.

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Severe Adverse Toxic Effects of Low-Dose Methotrexate Treatment on an Ectopic Pregnancy Patient With Methylenetetrahydrofolate Reductase Mutations: A Case Report

Frontiers in Medicine ◽

10.3389/fmed.2021.738315 ◽

2021 ◽

Vol 8 ◽

Author(s):

Huan Yu ◽

Wenhui Wang ◽

Haiyan Liang ◽

Kun Wang ◽

Bin Ling

Keyword(s):

Ectopic Pregnancy ◽

Low Dose ◽

Methylenetetrahydrofolate Reductase ◽

Rare Condition ◽

Skin Lesions ◽

Toxic Effects ◽

Literature Report ◽

Case Presentation ◽

Dose Methotrexate ◽

Life Threatening

Background: Low-dose methylenetetrahydrofolate (LD-MTX) has been widely used for the treatment of the ectopic pregnancy (EP) for many decades, and related severe adverse toxic effects are rare. Current studies have shown that the polymorphisms of methylenetetrahydrofolate reductase (MTHFR) gene can decrease the MTX clearance, leading to the metabolite accumulation. However, there is a lack of literature report on an MTHFR gene polymorphism associated with adverse toxic effects resulting from the use of LD-MTX in an EP.Case Presentation: We report a rare case of a 38-year-old female who developed persistent fever, grade IV myelosuppression, skin lesions, mucositis, and liver injury after single dose of LDMTX to treat EP. The personalized genetic testing showed that MTHFR TT (677C>T) and MTHFR AA (1298A>C) were detected. Gradually, the symptoms improved after calcium leucovorin (CF) rescue, continuous renal replacement therapy (CRRT), promoting blood system regeneration, and multiple supportive treatments.Conclusion: This is the first report on the serious adverse toxic effects of LD-MTX on an EP patient with MTHFR mutations. We aim to alert obstetricians and gynecologists to this rare condition. The unexpected life-threatening toxicity with LD-MTX should be highly considered and recognized early. In particular, some easily overlooked gastrointestinal, skin, and mucosal symptoms occur earlier than severe myelosuppression. When toxic effects are suspected, detecting the polymorphisms of an MTHFR gene and monitoring MTX concentration in blood could assist us to formulate individualized and active treatments.

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Renal Manifestations of Tuberous Sclerosis Complex

Journal of Kidney Cancer and VHL ◽

10.15586/jkcvhl.v7i3.131 ◽

2020 ◽

Vol 7 (3) ◽

pp. 5-19

Author(s):

Nikhil Nair ◽

Ronith Chakraborty ◽

Zubin Mahajan ◽

Aditya Sharma ◽

Sidarth Sethi ◽

...

Keyword(s):

Tuberous Sclerosis ◽

Tuberous Sclerosis Complex ◽

Gene Disruption ◽

Treatment Guidelines ◽

Renal Cysts ◽

Skin Lesions ◽

Multiple Organ ◽

Tsc2 Gene ◽

Genetic Condition ◽

Organ Systems

Tuberous sclerosis complex (TSC) is a genetic condition caused by a mutation in either the TSC1 or TSC2 gene. Disruption of either of these genes leads to impaired production of hamartin or tuberin proteins, leading to the manifestation of skin lesions, tumors and seizures. TSC can manifests in multiple organ systems with the cutaneous and renal systems being the most commonly affected. These manifestations can secondarily lead to the development of hypertension, chronic kidney disease, and neurocognitive declines. The renal pathologies most commonly seen in TSC are angiomyolipoma, renal cysts and less commonly, oncocytomas. In this review, we highlight the current understanding on the renal manifestations of TSC along with current diagnosis and treatment guidelines.

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Complicated cutaneous leishmaniasis caused by an imported case of Leishmania tropica in Japan: a case report

Tropical Medicine and Health ◽

10.1186/s41182-021-00312-4 ◽

2021 ◽

Vol 49 (1) ◽

Author(s):

Hiroyuki Kitano ◽

Chizu Sanjoba ◽

Yasuyuki Goto ◽

Kazumasa Iwamoto ◽

Hiroki Kitagawa ◽

...

Keyword(s):

Cutaneous Leishmaniasis ◽

Skin Lesions ◽

Leishmania Tropica ◽

Case Presentation ◽

Imported Case ◽

Imported Cases ◽

History Of ◽

Hematoxylin And Eosin ◽

Polymerase Chain ◽

Positive Results

Abstract Background Leishmaniasis is not endemic in Japan, and imported cases are rare. However, there are increasing concerns regarding imported cases of cutaneous leishmaniasis from endemic countries to Japan. This report describes a case of imported cutaneous leishmaniasis that was diagnosed and treated in Japan. Case presentation A 53-year-old Pakistani man presented with skin lesions on both malleoli of his right ankle and the dorsum of the left foot. The skin lesions manifested as erythematous nodules surrounding an ulcer in the center of the lesion. The lesions of the malleoli of his right ankle each measured 3 × 3 cm, and the lesion on the top of his left foot measured 5 × 4 cm. He had been living and working in Japan but had a history of a visit to Pakistan for about 2 months in 2018. The skin lesions were biopsied. Giemsa and hematoxylin and eosin staining of biopsy samples showed amastigotes of Leishmania in macrophages, and the presence of Leishmania was confirmed by skin tissue culture. Polymerase chain reaction using biopsy specimens identified Leishmania parasites, and DNA sequence analysis revealed that the species was Leishmania tropica. The patient was treated with intravenous liposomal amphotericin B for 6 days. The erythema disappeared, and the erythematous nodules resolved within 3 weeks. Conclusion This is the first report of imported cutaneous leishmaniasis caused by L. tropica from Pakistan, and it is interesting that all three testing modalities showed positive results in this case.

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Synchronous NET and colorectal cancer development: a case report

Surgical Case Reports ◽

10.1186/s40792-020-0777-4 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Shinsei Yumoto ◽

Yuji Miyamoto ◽

Takahiko Akiyama ◽

Yuki Kiyozumi ◽

Kojiro Eto ◽

...

Keyword(s):

Colorectal Cancer ◽

Colon Cancer ◽

Systemic Therapy ◽

Multiple Organ ◽

Cancer Development ◽

Sigmoid Colon Cancer ◽

Synchronous Tumors ◽

Case Presentation ◽

The Difference ◽

Rectal Neuroendocrine Tumor

Abstract Background The incidence of synchronous gastrointestinal neuroendocrine tumors (GI-NETs) and colorectal cancer is very low. Case presentation We present a 72-year-old man diagnosed with a rectal neuroendocrine tumor (NET) with multiple organ metastases and simultaneous sigmoid colon cancer. Although the NET was his prognostic factor, he underwent a laparoscopic sigmoidectomy at first because it was expected that the colon cancer would cause obstruction or bleeding during NET treatment. Subsequently, he started taking everolimus. Conclusions We should consider surgical resection of the synchronous cancer before systemic therapy for a GI-NET regardless of the difference in prognosis between synchronous tumors, if the cancer may impair the continuation of systemic therapy.

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Clinical and therapeutic correlations in patients with slight acute pancreatitis

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-67202015000100007 ◽

2015 ◽

Vol 28 (1) ◽

pp. 24-27 ◽

Cited By ~ 4

Author(s):

Clewis Henri MUNHOZ-FILHO ◽

Fernando BATIGÁLIA ◽

Hamilton Luiz Xavier FUNES

Keyword(s):

Acute Pancreatitis ◽

Intensive Care ◽

Vital Signs ◽

Positive Association ◽

Multiple Organ ◽

Glutamic Oxaloacetic Transaminase ◽

Serum Glutamic Oxaloacetic Transaminase ◽

Early Return ◽

Lower Spectrum ◽

Mild Acute Pancreatitis

BACKGROUND: Acute pancreatitis is an inflammatory disease of the pancreas due to enzymatic autodigestion which can cause necrosis or multiple organ failure; its pathophysiology is not fully known yet. AIM: To evaluate the correlation between clinical and therapeutic data in patients with mild acute pancreatitis. METHODS: A retrospective study in 55 medical records of patients admitted with acute mild pancreatitis was realized to analyze the association between age, leukocytosis, serum glutamic-oxaloacetic transaminase and lactate dehydrogenase, glucose, antibiotics, time admission and Ranson´s scores. RESULTS: There was a positive association between less intensive care (strict hydration, analgesia and monitoring of vital signs), early antibiotic therapy (monotherapy), early return to diet after 48 hours and laboratory control of the serum amylase and lipase (high in the first week and decreasing after 10 days, without any prognostic value). CONCLUSIONS: Changes in the management of patients with mild acute pancreatitis, such as enteral nutrition, rational use of lower spectrum antibiotics and intensive care, have contributed significantly to the reduction of hospitalization time and mortality.

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ECTOPIC PREGNANCY SOCIAL MEDIA SUPPORT: AN ANALYSIS OF CONTENT AND ACCURACY OF FACEBOOK GROUPS FOR WOMAN EXPERIENCING ECTOPIC PREGNANCIES

Fertility and Sterility ◽

10.1016/j.fertnstert.2021.05.059 ◽

2021 ◽

Vol 116 (1) ◽

pp. e38-e39

Author(s):

Kaleigh A. Russell ◽

Roselyn Tran ◽

Mallory Stuparich ◽

Samar Nahas ◽

Sadikah Behbehani

Keyword(s):

Social Media ◽

Ectopic Pregnancy ◽

Ectopic Pregnancies

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Utility of a routine ultrasound for detection of ectopic pregnancies among women requesting abortion: a retrospective review

BMJ Sexual & Reproductive Health ◽

10.1136/bmjsrh-2020-200888 ◽

2020 ◽

pp. bmjsrh-2020-200888

Author(s):

Clara I Duncan ◽

John J Reynolds-Wright ◽

Sharon T Cameron

Keyword(s):

Risk Factors ◽

Ectopic Pregnancy ◽

Clinical Care ◽

Significant Risk ◽

Intrauterine Pregnancy ◽

Retrospective Case ◽

Case Record ◽

Ultrasound Findings ◽

Ectopic Pregnancies ◽

Record Review

IntroductionRoutine ultrasound may be used in abortion services to determine gestational age and confirm an intrauterine pregnancy. However, ultrasound adds complexity to care and results may be inconclusive, delaying abortion. We sought to determine the rate of ectopic pregnancy and the utility of routine ultrasound in its detection, in a community abortion service.MethodsRetrospective case record review of women requesting abortion over a 5-year period (2015–2019) with an outcome of ectopic pregnancy or pregnancy of unknown location (PUL) at a service (Edinburgh, UK) conducting routine ultrasound on all women. Records were searched for symptoms at presentation, development of symptoms during clinical care, significant risk factors and routine ultrasound findings.ResultsOnly 29/11 381 women (0.25%, 95% CI 0.18%, 0.33%) had an ectopic pregnancy or PUL (tubal=18, caesarean scar=1, heterotopic=1, PUL=9). Eleven (38%) cases had either symptoms at presentation (n=8) and/or significant risk factors for ectopic pregnancy (n=4). A further 12 women developed symptoms during their clinical care. Of the remaining six, three were PUL treated with methotrexate and three were ectopic (salpingectomy=2, methotrexate=1). In three cases, the baseline ultrasound indicated a probable early intrauterine pregnancy.ConclusionsEctopic pregnancies are uncommon among women presenting for abortion. The value of routine ultrasound in excluding ectopic pregnancy in symptom-free women without significant risk factors is questionable as it may aid detection of some cases but may provide false reassurance that a pregnancy is intrauterine.

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Heterotopic pregnancy; case report

National Journal of Research in Ayurved Science ◽

10.52482/ayurlog.v7i05.425 ◽

2019 ◽

Vol 7 (05) ◽

Author(s):

Vipul R. Khandagale

Keyword(s):

Risk Factors ◽

Ectopic Pregnancy ◽

Adnexal Mass ◽

Heterotopic Pregnancy ◽

Free Fluid ◽

Threatening Condition ◽

Life Threatening ◽

Ectopic Pregnancies ◽

High Index Of Suspicion ◽

Low Risk Women

Heterotopic pregnancy is a rare clinical condition in which intrauterine and extrauterine pregnancies occur at the same time. It can be a life threatening condition and easily missed with the diagnosis. We present the case of a 37 year old patient who was treated for a heterotopic pregnancy with live intrauterine gestation and ruptured left adnexal gestation.The ectopic pregnancy was not suspected at her initial presentation. A high index of suspicion is needed in women with risk factors for an ectopic pregnancy and in low risk women who have free fluid with or without an adnexal mass with an intrauterine gestation.It is difficult to estimate exactly the incidence of ectopic pregnancies, but on an average it is approximately 1:300 normal pregnancies worldwide.

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