Combined acute interstitial pneumonitis and pancytopenia induced by low-dose methotrexate in a hemodialysis patient treated for bullous pemphigoid*
نویسندگان
چکیده
Methotrexate has been widely used for many years in the treatment of a variety of diseases. Acute pneumonitis and bone marrow suppression are very serious side effects in methotrexate treatment. A 48-year-old man with end-stage renal disease undergoing chronic hemodialysis developed combined acute pneumonitis and pancytopenia after a cumulative dose of 20 mg methotrexate for bullous pemphigoid. Continuous renal replacement therapy (CRRT) can efficiently decrease serum methotrexate concentration. A rapid improvement of clinical symptoms and resolution of pulmonary opacification were found after CRRT. Blood cell counts returned to normal after component blood transfusion and cytokine supportive therapy. Patients with impaired renal function are at high risk of methotrexate toxicity, and low-dose methotrexate should be prescribed with great caution.
منابع مشابه
[Toxicity of low-dose methotrexate in rheumatoid arthritis--clinical characteristics in patients with MTX-induced pancytopenia and interstitial pneumonitis].
Pancytopenia and interstitial pneumonitis are one of the most serious and unpredictable adverse effects of low dose, pulse methotrexate (MTX) in treating rheumatoid arthritis (RA). It is important to investigate the historical, clinical or immunologic features associated with the development of such toxicity, in order to use MTX more appropriately. Two hundred eighty four patients (female 230 m...
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Background: Bullous pemphigoid (BP) is an autoimmune cutaneous blistering disorder. The precise precipitating etiology is not clear. There has been documented Drug-induced BP in case reports. Case report: We describe a case of a 44year old female with a past medical history of Psoriasis, who developed bullous pemphigoid. She had previously been on maintenance dose of 10mg intravenous methotrexa...
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A Case of Acute Myeloid Leukemia Caused by Low Dose Methotrexate Used to Treat a Rheumatoid Arthritis Patient
Methotrexate is an anti-rheumatic agent used as a first-line tretment for rheumatoid arthritis. Hematological malignancies like lymphoma or acute myeloid leukemia have been reported to be secondary to treatment with Methotrexate, but are very uncommon. We report here the first Moroccan case of RA patient on low dose MTX, who developed AML. We also reviewed all similar cases.
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