Life-Threatening Gastrointestinal Mucosal Necrosis during Methotrexate Treatment for Rheumatoid Arthritis
نویسندگان
چکیده
Methotrexate (MTX), a folic acid antagonist, is widely used in the treatment of neoplasms, psoriasis and rheumatoid arthritis. Despite its efficacy, MTX sometimes finds limited application because of its adverse effects, including renal or liver impairment, bone marrow toxicity and gastrointestinal mucosal injury. Intestinal mucositis, bleeding and peptic ulcers are well-known gastrointestinal adverse effects of MTX, although cases of fatal mucosal necrosis induced by MTX are extremely rare. Here, we report the case of an 82-year-old Japanese woman who developed severe gastrointestinal mucosal necrosis after 8 years of treatment with low-dose MTX (8 mg/week). In the drug lymphocyte stimulation test, MTX showed a strong positive reaction, with a stimulation index of 443% against normal controls. Physicians must be aware of potential drug-induced adverse effects in patients with chronic diseases who are on long-term medication.
منابع مشابه
Life threatening acute pneumonitis during low dose methotrexate treatment for rheumatoid arthritis: a case report and review of the literature.
A patient is described with definite rheumatoid arthritis (RA) who developed life threatening acute pneumonitis after receiving a total dose of only 12.5 mg methotrexate (MTX). This complication has been previously described, but this is probably the lowest reported dose before development of pneumonitis in a patient with RA. The possible significance of this case is discussed in the light of r...
متن کاملA 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.
متن کاملLiver Toxicity in Rheumatoid Arthritis Patients Treated With Methotrexate
Background:Methotrexate (MTX) is one of the most commonly used disease-modifying antirheumatic drugs in the treatment of rheumatoid arthritis (RA) which can be associated with toxic effects on different organs. This study was designed to investigate the hepatotoxic effects in RA patients treated with MTX. Methods: In this cross-sectional observational study, RA patients who received standard d...
متن کاملAcute pneumonitis associated with low dose methotrexate treatment for rheumatoid arthritis.
BACKGROUND Low dose methotrexate has become established in the treatment of refractory rheumatoid arthritis. Until recently it has been considered that the use of a low dose regimen (< 20 mg/week) would avoid the pulmonary toxicity associated with the higher doses prescribed in malignant disease. Although initial experience with low dose methotrexate was encouraging, an increasing number of cas...
متن کاملCombination therapy in rheumatoid arthritis.
It has become clear that early suppression of rheumatoid arthritis disease activity is important in preventing progressive joint destruction and functional decline. To achieve this goal, many rheumatologists today advocate a more aggressive approach, using combinations of classic disease-modifying antirheumatic drugs-often including methotrexate-or new drugs. During the last 2 years, the combin...
متن کامل