title: The efficiency of granulocyte colony-stimulating factor in hemorrhagic mucositis and febrile neutropenia resulted from methotrexate toxicity.
abstract: Methotrexate (MTX) remains one of the most frequently used anti-metabolite agents in dermatology. MTX is an analog of folate that competitively and irreversibly inhibits dihydrofolate reductase. Oral mucositis is a common side effect of chemotherapy drugs and is characterized by erythema, pain, poor oral intake, pseudomembranous destruction, open ulceration and hemorrhage of the oral mucosa. In this paper, we report a 32-year-old female with a case of mucositis due to MTX intoxication that resulted from an overdose for rheumatoid arthritis. The patient had abdominal pain, vomiting, and nausea. During follow-up, the patient's white blood cell count was found to be 0.9 × 10(9)/L (4-10 × 10(9)/L). The patient developed fever exceeding 40 °C. The patient was consulted to the hematology service. They suggested using granulocyte colony-stimulating factor for febrile neutropenia. On the fifth day of treatment, the white blood cell count reached 5.3 × 10(9)/L and the patient's fever and mucositis started to resolve. Here, we presented a case of hemorrhagic mucositis and febrile neutropenia resulted from high-dose MTX that responded very well to granulocyte colony-stimulating factor treatment and we reviewed the literature.
authors: Department of Dermatology, Yuzuncu Yil University, Faculty of Medicine , Van , Turkey .
authors: Hatice Uce
authors: HU
authors: Ozkol
authors: Tayfur
authors: T
authors: Toptas
authors: Omer
authors: O
authors: Calka
authors: Necmettin
authors: N
authors: Akdeniz
mesh_terms: D000328:Adult; D064147:Febrile Neutropenia / Q000139:chemically induced / Q000188:drug therapy*; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced / Q000188:drug therapy*; D006801:Humans; D008727:Methotrexate / Q000009:adverse effects*; D009061:Mouth Mucosa / Q000473:pathology*; D052016:Mucositis / Q000139:chemically induced / Q000188:drug therapy*
chemical_list: D016179:Granulocyte Colony-Stimulating Factor; D008727:Methotrexate
keywords: Febrile neutropenia; granulocyte colony-stimulating factor; mucositis