title: Methotrexate induced pancytopenia.
abstract: The well-reported methotrexate (MTX) toxicities are based on the duration and cumulative dosing of drug. The typical toxicities can be predicted by the timing of drug administration, where mucositis occurs as an earlier effect, while myelosuppression and the sequelae of pancytopenia occur later after MTX administration. Despite these well-known toxicities, low dose MTX therapy can become problematic, in particular with the elderly, who are at a greater risk for significant myelosuppression. We present a case of a 73-year-old female with pancytopenia causing severe neutropenia, mucocutaneous bleeding, and bruising and requiring intravenous antibiotic therapy and limited transfusion dependence as a result of low dose daily MTX for rheumatoid arthritis.
authors.affiliation: Department of Internal Medicine, Mount Sinai School of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USA.
authors.forename: Fernando
authors.identifier: 0000-0001-9136-1108
authors.initials: F
authors.lastname: Gonzalez-Ibarra
authors.affiliation: Department of Internal Medicine, Mount Sinai School of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USA.
authors.forename: Sahar
authors.initials: S
authors.lastname: Eivaz-Mohammadi
authors.affiliation: Department of Internal Medicine, Mount Sinai School of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USA.
authors.forename: Shiri
authors.initials: S
authors.lastname: Surapaneni
authors.affiliation: Department of Internal Medicine, Jersey City Medical Center, St. George's University School of Medicine, Jersey City, NJ 07302, USA.
authors.forename: Hazem
authors.initials: H
authors.lastname: Alsaadi
authors.affiliation: Laureate National Institute of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USA.
authors.forename: Amer K
authors.initials: AK
authors.lastname: Syed
authors.affiliation: Department of Hematology, Mount Sinai School of Medicine, Jersey City Medical Center, Jersey City, NJ 07302, USA.
authors.forename: Simon
authors.identifier: 0000-0001-5606-8053
authors.initials: S
authors.lastname: Badin
authors.affiliation: Department of Rheumatology, Mount Sinai School of Medicine, Jersey City Medical Center, Jersey City, NJ 07302, USA.
authors.forename: Valentin
authors.identifier: 0000-0003-1425-8435
authors.initials: V
authors.lastname: Marian
authors.affiliation: Department of Internal Medicine, Mount Sinai School of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USA.
authors.forename: Mazhar
authors.initials: M
authors.lastname: Elamir