title: Methotrexate and actinomycin D chemotherapy in a patient with porphyria: a case report.
abstract: BACKGROUND
  Despite their broadly recommended use as chemotherapeutic agents, the porphyrogenicity of methotrexate and actinomycin D have not been confirmed. Accordingly, it is not known whether these agents are safe for use in patients with porphyria.
  
  
  METHODS
  In this report, we present a case of an invasive mole with lung metastasis in a 49-year-old Japanese woman who had previously been diagnosed with acute intermittent porphyria at 27 years of age but had no recent history of acute intermittent porphyria attacks. Her serum human chorionic gonadotropin level was elevated 1 month after hysterectomy, and she was referred to our center for chemotherapy. After she received 100 mg of methotrexate, drug eruptions were observed starting on day 3 and grew progressively worse. Erythema and mucosal erosion spread throughout her body, whereupon she was administered prednisolone. In addition, our patient experienced febrile neutropenia and required granulocyte colony- stimulating factor treatment. No changes in our patient's urinary coproporphyrin or uroporphyrin levels were detected during this entire episode. Methotrexate was replaced by actinomycin D (0.5 mg/body intravenously on days 1-5 every 2 weeks). After five uneventful cycles of actinomycin D, our patient achieved and maintained a normal serum human chorionic gonadotropin level for 3 years.
  
  
  CONCLUSIONS
  Methotrexate and actinomycin D did not induce acute porphyric attacks in this patient with acute intermittent porphyria; however, severe adverse effects were noted with methotrexate. Although further investigation is required, our data suggest that these agents are nonporphyrinogenic and can therefore be used to treat patients with comorbid porphyria.
authors.affiliation: Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama, 350-8550, Japan. ymikami@saitama-med.ac.jp.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Mikami
authors.affiliation: Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama, 350-8550, Japan. tomono@saitama-med.ac.jp.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Nagai
authors.affiliation: Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama, 350-8550, Japan. gomi_md@yahoo.co.jp.
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Gomi
authors.affiliation: Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama, 350-8550, Japan. yastakai@saitama-med.ac.jp.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Takai
authors.affiliation: Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama, 350-8550, Japan. saimasa@saitama-med.ac.jp.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Saito
authors.affiliation: Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama, 350-8550, Japan. bababa@saitama-med.ac.jp.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Baba
authors.affiliation: Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama, 350-8550, Japan. h_seki@saitama-med.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Seki
mesh_terms: D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006063:Chorionic Gonadotropin / Q000097:blood*; D003609:Dactinomycin / Q000627:therapeutic use*; D003875:Drug Eruptions / Q000188:drug therapy / Q000209:etiology; D005260:Female; D006801:Humans; D002820:Hydatidiform Mole, Invasive / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D007044:Hysterectomy; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000556:secondary; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D017118:Porphyria, Acute Intermittent / Q000150:complications*; D011247:Pregnancy; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
chemical_list: D000903:Antibiotics, Antineoplastic; D000970:Antineoplastic Agents; D006063:Chorionic Gonadotropin; D003609:Dactinomycin; D008727:Methotrexate