Life-Threatening Gastrointestinal Mucosal Necrosis during Methotrexate Treatment for Rheumatoid Arthritis

Case Reports in Gastroenterology
Tomoya TsukadaShozo Sasaki

Abstract

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.

Citations

Jun 3, 2014·Head & Face Medicine·Tobias AnnussekKai Wermker
Apr 5, 2016·Pharmacognosy Magazine·Azza A El-SheikhAzza H Hamouda
Oct 24, 2015·Joint, Bone, Spine : Revue Du Rhumatisme·Ségolène ToquetFirouzé Bani-Sadr
Jul 30, 2016·Archives of Pathology & Laboratory Medicine·Esmeralda Celia Marginean
Nov 3, 2016·Experimental Animals·Aynur ArslanHalis Suleyman
Dec 17, 2020·Biotechnic & Histochemistry : Official Publication of the Biological Stain Commission·S KocM M Erdogan
May 28, 2021·Journal of Investigative Medicine High Impact Case Reports·Folake J Lawal, Stephanie L Baer

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BETA
biopsy

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