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

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.

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

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Valéry Refeno ◽  
Naharisoa Giannie Rasamimanana ◽  
Baco Abdallah Abasse ◽  
Malalafinaritra Patrick Marco Ramarokoto ◽  
Mahefaniaina Jean Eustache Fanomezantsoa ◽  
...  
Keyword(s):  
Intensive Care ◽  
Ectopic Pregnancy ◽  
Skin Lesions ◽  
Multiple Organ ◽  
African Woman ◽  
Case Presentation ◽  
Gynecology And Obstetrics ◽  
Severe Pancytopenia ◽  
Ectopic Pregnancies ◽  
Febrile Jaundice

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.

scholarly journals A life-threatening case of pregnancy-related atypical Haemolytic uremic syndrome and successful treatment with Eculizumab

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Prianka Puri ◽  
Anida Hanxhiu ◽  
Daniel V. O’Hara ◽  
Danny Hsu ◽  
Mirna Vucak-Dzumhur
Keyword(s):  
Kidney Injury ◽  
Rare Condition ◽  
Foetal Death ◽  
Case Presentation ◽  
Haemolytic Uremic Syndrome ◽  
Genetic Sequencing ◽  
Planned Pregnancy ◽  
Life Threatening ◽  
Uremic Syndrome ◽  
Antenatal Visits

Abstract Background Pregnancy-related Atypical Haemolytic Uremic Syndrome (P-aHUS) is a rare condition affecting genetically predisposed women during pregnancy. It is often difficult to diagnose and has a significant impact on maternal and foetal outcomes. It is characterised by microangiopathic haemolytic anaemia and kidney injury from thrombotic microangiopathy. Case presentation A 27-year-old female of Lebanese descent presented at 36 weeks’ gestation with foetal death in-utero (FDIU) with placental abruption on a background of previously normal antenatal visits. She was coagulopathic and anaemic with anuric acute kidney injury, requiring emergency Caesarean section, intubation and dialysis. Her coagulopathy rapidly resolved, however, her anaemia and renal dysfunction persisted. A diagnosis of P-aHUS was made, and she was empirically treated with Eculizumab. Her ADAMTS13 level was normal, effectively excluding thrombotic thrombocytopenic purpura. Within 2 weeks of treatment her haematological parameters improved, and her renal function began to recover and within 2 months she became dialysis independent. Conclusion This case highlights the challenges of a timely diagnosis of P-aHUS from other pregnancy-related diseases. Although our patient is dialysis-independent, her risk of relapse remains high with subsequent pregnancies. Currently we are awaiting her genetic sequencing to complete her assessment for underlying mutations and are determining the safest approach to a future planned pregnancy.

Low-dose methotrexate treatment in ectopic pregnancy: a retrospective analysis of 164 ectopic pregnancies treated between 2000 and 2008

2013 ◽  
Vol 289 (2) ◽  
pp. 329-335 ◽  
Author(s):  
Johannes Lermann ◽  
Petra Segl ◽  
Sebastian M. Jud ◽  
Matthias W. Beckmann ◽  
Peter Oppelt ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Retrospective Analysis ◽  
Low Dose ◽  
Dose Methotrexate ◽  
Methotrexate Treatment ◽  
Ectopic Pregnancies

scholarly journals Acute Methotrexate Toxicity: A Fatal Condition in Two Cases of Psoriasis

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Pankti Jariwala ◽  
Vinay Kumar ◽  
Khyati Kothari ◽  
Sejal Thakkar ◽  
Dipak Dayabhai Umrigar
Keyword(s):  
Bone Marrow ◽  
Drug Interactions ◽  
Creatinine Level ◽  
Joint Pain ◽  
Low Dose ◽  
Skin Lesions ◽  
Bone Marrow Suppression ◽  
Intermittent Treatment ◽  
Self Medication ◽  
Dose Methotrexate

We describe two fatal cases of low dose methotrexate (MTX) toxicity in patients with psoriasis, emphasizing the factors that exacerbate MTX toxicity. The first patient was a 50-year-old male of psoriasis on intermittent treatment with MTX. After a treatment-free period of six months, he had self-medication of MTX along with analgesic for joint pain for one week which followed ulceration of the lesions, bone marrow suppression, and eventually death. The second patient was a 37-year-old male of psoriasis, who has taken MTX one week earlier without prior investigations. He had painful ulcerated skin lesions and bone marrow suppression. On investigations, he showed high creatinine level and atrophied, nonfunctioning right kidney on ultrasonography. In spite of dialysis, he succumbed to death. MTX is safe and effective if monitored properly, but inadvertent use may lead to even death also. Prior workup and proper counseling regarding the drug interactions as well as self-medication should be enforced.

scholarly journals Cutaneous elastorrhexis; A Heralding Sign of Gronblad-Strandberg Syndrome: A Case Report

2020 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Ravindranath Brahmadeo Chavan ◽  
Nitika S Deshmukh ◽  
Vasudha Abhijit Belgaumkar ◽  
Vijay Raut
Keyword(s):  
Autosomal Recessive Disorder ◽  
Pseudoxanthoma Elasticum ◽  
Skin Lesions ◽  
Lateral Side ◽  
Systemic Complications ◽  
Case Presentation ◽  
Skin Changes ◽  
Clinical Criteria ◽  
Heritable Disorder ◽  
Life Threatening

Introduction: Pseudoxanthoma Elasticum (PXE), also called Gronblad-Strandberg syndrome, is an autosomal recessive disorder due to mutation in the ABCC6 allele on chromosome 16p. It is characterized by the progressive fragmentation and calcification of elastin fibers of the dermis, blood vessels, and Bruch’s membrane of the eye. In this article, the authors present a case of PXE with cutaneous elastorrhexis. Case Presentation: A 31-year-old female presented with skin changes in the form of yellowish linearly arranged papules over the lateral side of the neck and anterior abdomen since adolescence. Her retinoscopy and cardiovascular examinations were reported as normal. The molecular analysis could not be done due to financial limitations. Based on these findings, the patient was suspected of PXE according to the revised criteria for the diagnosis of PXE. Conclusions: Skin lesions are generally first to appear in adolescence. Ocular findings develop at later ages, i.e., third or fourth decades. Cardiovascular manifestations develop later in life. Hence, skin changes can aid in the early diagnosis of PXE and help clinicians to screen patients for systemic complications. Being a multisystem heritable disorder with morbidity and mortality, there is a need to formulate the clinical criteria for definitive diagnosis in resource-poor settings where molecular assays cannot be performed. The recognition of typical skin lesions can aid in the accurate diagnosis to facilitate the early detection and management of life-threatening systemic complications.

Early-onset pancytopenia and skin ulcer following low-dose methotrexate therapy

2008 ◽  
Vol 27 (7) ◽  
pp. 585-589 ◽  
Author(s):  
N Hocaoglu ◽  
R Atilla ◽  
F Onen ◽  
Y Tuncok
Keyword(s):  
Adverse Effect ◽  
Early Onset ◽  
Low Dose ◽  
Skin Ulcer ◽  
Initial Examination ◽  
Cutaneous Lesions ◽  
Folate Supplementation ◽  
Dose Methotrexate ◽  
Life Threatening ◽  
Severe Pancytopenia

Pancytopenia is a rare but serious adverse effect of low-dose methotrexate (MTX) sodium therapy, and this case report describes a very early-onset of pancytopenia and cutaneous lesions after three days of ingestion. A 64-year-old man was presented to Emergency Department with weakness, fever, poor appetite, nausea, and vomiting after he had had accidentally ingested MTX tablets (2.5 mg) twice a day for the last three days. On initial examination, several painful lesions in his oral mucosa and a cutaneous ulceration on his right foot were also observed. He had severe pancytopenia, poor kidney functions, and abnormal coagulation parameters. The blood level of MTX was found to be within therapeutic range. He was treated with leucovorine, intravenous antibiotics, and appropriate blood transfusions; he was discharged from hospital without any sequela. Pancytopenia associated with low-dose (cumulative dose of 15 mg in 3 days) MTX therapy had not been reported previously. The Naranjo probability scale showed pancytopenia and skin ulcer associated with low-dose MTX therapy as probable adverse reactions. Risk factors for pancytopenia such as renal insufficiency, hypoalbuminemia, low folate levels, concomitant infections, concomitant use of drugs, and folate supplementation were not identified in our patient. Although pancytopenia associated with low-dose MTX therapy is not expected as early as 3 days after initiation of the therapy, physicians should also be aware of this life threatening adverse effect during the very first days of MTX therapy for rheumatoid arthritis patients.

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