title: Life-threatening complications following multidose methotrexate for medical management of ectopic pregnancy.
abstract: A 25-year-old primigravida was diagnosed to be suffering from unruptured ectopic pregnancy. The serum β-human chorionic gonadotropin levels were 2851 mIU/l and the ectopic gestational sac was 2.7×2.7 cm without any fetal pole. It was decided to manage her by expectant therapy. But she received medical therapy with multidose methotrexate because of misinterpretation of expectant therapy as medical therapy. She suffered from methotrexate toxicity, which manifested as high-grade fever, vomiting, melena, oral ulcerations, pneumonitis, subconjunctival haemorrhages and skin pigmentation. She developed severe third space fluid collection and shock, which was mistaken for rupture ectopic gestation. Her haematological picture showed severe neutropaenia and thrombocytopaenia which confirmed the clinical picture to be due to methotrexate toxicity. She also developed septicaemia and candidal infection secondary to immunosuppression. She was managed in intensive care unit with ventilatory support, high-dose leucovorin and injection filgastrim. She responded well to the therapy with dramatic recovery in 4 days.
authors.affiliation: Department of Obstetrics and Gynaecology, JIPMER, Puducherry, India. dasaripapa@gmail.com
authors.forename: Papa
authors.initials: P
authors.lastname: Dasari
authors.forename: Haritha
authors.initials: H
authors.lastname: Sagili
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000506:poisoning*; D000032:Abortion, Therapeutic / Q000009:adverse effects; D000328:Adult; D005260:Female; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D002955:Leucovorin / Q000627:therapeutic use; D019300:Medical Errors / Q000009:adverse effects*; D008727:Methotrexate / Q000506:poisoning*; D009503:Neutropenia / Q000139:chemically induced / Q000628:therapy; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000188:drug therapy*; D011994:Recombinant Proteins / Q000627:therapeutic use; D012121:Respiration, Artificial; D018805:Sepsis / Q000139:chemically induced / Q000628:therapy; D012769:Shock / Q000139:chemically induced / Q000628:therapy; D013921:Thrombocytopenia / Q000139:chemically induced / Q000628:therapy; D014803:Vitamin B Complex / Q000627:therapeutic use
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D011994:Recombinant Proteins; D014803:Vitamin B Complex; D016179:Granulocyte Colony-Stimulating Factor; D000069585:Filgrastim; D002955:Leucovorin; D008727:Methotrexate