Toxicity Due to High Dose Methotrexate In A Patient With Rheumatoid Arthritis: Case Report

Abstract

Rheumatoid arthritis (RA) is a systemic inflammatory disease whose etiology is not fully known and is characterised by destruction of synovial membrane which is caused by inflammation in the joints and synovial cell proliferation. Methotrexate (MTX) is one of disease-modifying antirheumatic drugs (DMARDs) that is used at low doses and at weekly intervals in the treatment of rheumatoid arthritis. At high doses of MTX, toxicity such as bone marrow suppression, mucositis, liver and kidney dysfunction may occur. Pancytopenia and mucositis caused by methotrexate overdose can be treated with calcium folinate and filgrastim. In our case report, we presented a patient who accidentally took 15 mg/day MTX when was being treated with weekly based low-dose 15 mg/week MTX, as a result developed serious side effects such as pancytopenia and mucositis. Especially for medications that require careful handling, appropriate training and detailed information should be given to patients and their relatives and patients should be frequently monitored.

Keywords

• methotrexate
• toxicity
• pancytopenia
• mucositis