A 69-year-old female patient was admitted to our emergency service with painful oral ulcers and rectal bleeding. She has been used methotrexate (MTX) because of rheumatoid arthritis (RA). The patient has been used methotrexate every day for 10 days instead of a weekly treatment. Pancytopenia was seen in laboratory tests. Rectal bleeding associated with gastrointestinal mucosal erosion was attributed to MTX toxicity and MTX-induced thrombocytopenia. The direct cause of MTX intoxication in this case was accidental daily use instead of a weekly use. This case demonstrates the importance of communicating adequately with health professionals and emphasizes that MTX should be used weekly. It is essential to describe in detail how the medication can be used and what adverse effects may occur as the result of taking MTX.

In this article, we are sharing a case of a 76-year-old woman with known hypertension, atrial fibrillation, diabetes mellitus, coronary artery disease, who is presenting with stomach necrosis and perforation possibly due to celiac artery thrombosis after newly developed abdominal pain and bloody vomiting. In our case, emergency surgery was planned and the patient refused the operation and was lost at 48 hours of clinical follow-up. We aimed to discuss the etiology of celiac artery thrombosis, briefly. We believe that necrosis and perforation of the stomach due to celiac artery thrombosis deserves to be shared because it is a rare and difficult case to manage.

Gestational diabetes mellitus (GDM) is one of the most common medical complications in pregnancy and has become a global public health issue in terms of causing fetal and maternal morbidity and mortality in shortand long-term. The number of cases of GDM all over the world has been increasing day by day and they include risks for mother and baby health compared to healthy pregnancies. GDM screening and diagnostic phase has complete different approaches and there is no common consensus. Once GDM is diagnosed, pharmacologic treatment can be necessary in addition to strict blood sugar follow-up, regular exercise, and diet regulation. In postpartum period, medical monitoring is also necessary due to increased risk of diabetes mellitus in women with GDM. In this paper, we will also discuss approaches suggested in the GDM in the context of current guidelines and literature.

Multiple myeloma is a malignant disease that results in the proliferation of a single plasma cell clone. The clinical manifestations are anemia, bone pain, bone fractures, hypercalcemia, hypergammaglobulinemia, increased erythrocyte sedimentation rate, rouleaux formation on the peripheral blood smear and rarely increased serum viscosity. Rarely cast nephropathy associated with acute renal failure may be the first finding of multiple myeloma. We report a clinical case of a 44-year-old female patient who presented with acute renal failure due to cast nephropathy without myeloma’s typical clinical and laboratory findings. In the clinical case presented here, we highlight that multiple myeloma can be presented with acute renal failure and without any other typical symptoms.