title: Almost a tragedy: severe methotrexate toxicity in a hemodialysis patient treated for ectopic pregnancy.
abstract: BACKGROUND
  Methotrexate (MTX), an antimetabolite of folic acid, is the drug of choice for the nonsurgical management of ectopic pregnancy. MTX-related toxicity may include leukopenia, thrombocytopenia, pancytopenia, nausea, vomiting, stomatitis, mucositis, and liver and lung toxicity, depending primarily on the dosage of the drug and patients' renal function. Currently, the use of MTX in hemodialysis patients, even at a low dosage, is controversial, and no clear-cut guidelines are available.
  
  
  METHODS
  We report here a rare case of a life-threatening complication characterized by severe pancytopenia and skin and mucosal injury, which developed in a young patient on hemodialysis after oral treatment with MTX for ectopic pregnancy.
  
  
  CONCLUSIONS
  We conclude that even low-dose MTX administration is not to be used in patients with renal insufficiency, and when no other therapeutic options are available we suggest taking several clinical measures to prevent or treat myelosuppression.
authors.affiliation: Department of Internal Medicine B, Bnai-Zion Hospital, Haifa, Israel, nadav.willner@gmail.com.
authors.forename: Nadav
authors.initials: N
authors.lastname: Willner
authors.forename: Shimon
authors.initials: S
authors.lastname: Storch
authors.forename: Tamar
authors.initials: T
authors.lastname: Tadmor
authors.forename: Elad
authors.initials: E
authors.lastname: Schiff
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D052016:Mucositis / Q000139:chemically induced; D010198:Pancytopenia / Q000139:chemically induced; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000188:drug therapy*; D006435:Renal Dialysis; D012720:Severity of Illness Index; D012867:Skin / Q000187:drug effects / Q000473:pathology; D055815:Young Adult
chemical_list: D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate