title: Life-Threatening Gastrointestinal Mucosal Necrosis during Methotrexate Treatment for Rheumatoid Arthritis.
abstract: Methotrexate (MTX), a folic acid antagonist, is widely used in the treatment of neoplasms, psoriasis and rheumatoid arthritis. Despite its efficacy, MTX sometimes finds limited application because of its adverse effects, including renal or liver impairment, bone marrow toxicity and gastrointestinal mucosal injury. Intestinal mucositis, bleeding and peptic ulcers are well-known gastrointestinal adverse effects of MTX, although cases of fatal mucosal necrosis induced by MTX are extremely rare. Here, we report the case of an 82-year-old Japanese woman who developed severe gastrointestinal mucosal necrosis after 8 years of treatment with low-dose MTX (8 mg/week). In the drug lymphocyte stimulation test, MTX showed a strong positive reaction, with a stimulation index of 443% against normal controls. Physicians must be aware of potential drug-induced adverse effects in patients with chronic diseases who are on long-term medication.
authors.affiliation: Department of Gastroenterologic Surgery, Kanazawa University, Kanazawa, Japan ; Department of Surgery, Asanogawa General Hospital, Kanazawa, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Tsukada
authors.affiliation: Department of Surgery, Asanogawa General Hospital, Kanazawa, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Nakano
authors.affiliation: Department of Gastroenterologic Surgery, Kanazawa University, Kanazawa, Japan ; Department of Surgery, Asanogawa General Hospital, Kanazawa, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Miyata
authors.affiliation: Department of Surgery, Asanogawa General Hospital, Kanazawa, Japan.
authors.forename: Shozo
authors.initials: S
authors.lastname: Sasaki
keywords: Adverse effect; Drug lymphocyte stimulation test; Gastrointestinal tract; Methotrexate; Mucosal injury; Necrosis; Rheumatoid arthritis; Type IV allergic reactions