Fatal pancytopenia in a hemodialysis patient after treatment with low-dose methotrexate.
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.
Cheung
Kitty Kit Ting
KK
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, SAR, The People's Republic of China.
Chow
Kai Ming
KM
Szeto
Cheuk Chun
CC
Tai
Morris Hok Leung
MH
Kwan
Bonnie Ching Ha
BC
Li
Philip Kam Tao
PK
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*
D018501:Antirheumatic Agents; D003879:Dermatologic Agents; D008727:Methotrexate