Abstract

A CASE REPORT ON CHRONIC METHOTREXATE TOXICITY

Kasu Vyshnavi*, Akshima Gupta, Myakala Soumya, Dr. Nikhil Kumar Vanjari

ABSTRACT

Methotrexate(MTX) is a most commonly used Disease-modifying antirheumatic drug(DMARD) administered weekly in low doses which is a mainstay in the therapy of rheumatoid arthritis. A patient with rheumatoid arthritis, under methotrexate therapy, developed severe pancytopenia, bone marrow suppression, hepatotoxicity, renal dysfunction, neurotoxicity, gastrointestinal and mucocutaneous symptoms. Methotrexate was suspected to cause above clinical toxicities and administration of methotrexate was stopped and leucovorin(folinic acid) which is an antidote for Methotrexate toxicity was given. A recovery of clinical symptoms and normalization of liver function tests and renal function tests was observed. In that sense, leucovorin is found to be best rescue from methotrexate toxicity. An overview of the literature regarding the mechanism of action, clinical features, toxicity, management of methotrexate is presented.

Keywords: Methotrexate, Leucovorin, Rheumatoid arthritis, Folate, thrombocytopenia.