title: Fatal pancytopenia in a hemodialysis patient after treatment with low-dose methotrexate.
abstract: We report a 56-year-old male hemodialysis patient who developed fatal pancytopenia after treatment with low-dose methotrexate for psoriasis and psoriatic arthropathy. Risk factors identified included impaired renal function, concurrent use of nonsteroidal anti-inflammatory drugs, low serum albumin, and relatively low serum folate level. Literature review found similar risk factors in 12 other cases. Therefore, methotrexate, even as a single dose, should not be used to treat rheumatic conditions in dialysis patients.
authors.affiliation: Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, SAR, The People's Republic of China.
authors.forename: Kitty Kit Ting
authors.initials: KK
authors.lastname: Cheung
authors.forename: Kai Ming
authors.initials: KM
authors.lastname: Chow
authors.forename: Cheuk Chun
authors.initials: CC
authors.lastname: Szeto
authors.forename: Morris Hok Leung
authors.initials: MH
authors.lastname: Tai
authors.forename: Bonnie Ching Ha
authors.initials: BC
authors.lastname: Kwan
authors.forename: Philip Kam Tao
authors.initials: PK
authors.lastname: Li
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000188:drug therapy; D003879:Dermatologic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D010198:Pancytopenia / Q000139:chemically induced* / Q000175:diagnosis; D011565:Psoriasis / Q000188:drug therapy; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000628:therapy*
chemical_list: D018501:Antirheumatic Agents; D003879:Dermatologic Agents; D008727:Methotrexate