Pancytopenia after low dose methotrexate therapy in a hemodialysis patient: case report and review of literature

Renal Failure
Ching-Ping YangHung-Chun Chen

Abstract

Methotrexate (MTX) is widely used in the treatment of rheumatoid arthritis (RA) with a side effect of pancytopenia. However, only a few cases of severe pancytopenia caused by low-dose MTX therapy have been reported, and the condition is rarely reported in uremic patients on dialysis therapy. We thereby report a hemodialysis patient who developed severe pancytopenia after oral treatment with low-dose MTX for RA. A 55-year-old woman who had been on regular hemodialysis treatment for 7 yr suffered from RA for 10 yr. She was regularly treated with celecoxib, prednisolone, and sulfasalazine in the past year. Because of the increasing arthralgia, 7.5 mg per week MTX was prescribed 3 months before admission. Stomatitis, fever, general fatigue, multiple skin carbuncles, and easy bruising developed after a cumulative dose of 90 mg. Pancytopenia was found at admission and the nadir of white blood cell count was 250/microL with 28% neutrophils, hematocrit was 22%, and platelet count was 6000/microL. Eosinophil counts increased from 11.5% initially to 26.1% on the sixth admission day. Transfusion with red blood cells and platelets, and appropriate antibiotics and folic acid were prescribed. She continued receiving regular hemodialysis and ...Continue Reading

References

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Citations

Oct 30, 2010·Seminars in Arthritis and Rheumatism·Gabriela Schmajuk, Jinoos Yazdany
Apr 25, 2009·Journal of the American Academy of Dermatology·Robert E KalbMark Lebwohl
Apr 3, 2009·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Miho MurashimaRoy D Bloom
Mar 24, 2012·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Kimberly N FlynnDouglas L Smith
Nov 28, 2013·European Journal of Clinical Pharmacology·Nadav WillnerElad Schiff
Nov 28, 2012·Clinical Rheumatology·Raoul BergnerChristian Löffler
Jun 9, 2009·Journal of Clinical Rheumatology : Practical Reports on Rheumatic & Musculoskeletal Diseases·Kitty Kit Ting CheungPhilip Kam Tao Li
Mar 11, 2020·BMJ Open Ophthalmology·Clara M Castillejo BecerraAlexa Simon Meara
Oct 4, 2018·Jornal brasileiro de nefrologia : ʹorgão oficial de Sociedades Brasileira e Latino-Americana de Nefrologia·Arbey Aristizabal-AlzateGustavo Adolfo Zuluaga-Valencia

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