A Fatal Fate: A Medical Error Leading to Acute Methotrexate Toxicity

Abstract

Methotrexate is an anti-metabolite, which is commonly utilized as an anti-cancer, anti-rheumatic, and antiinflammatory drug used to treat a large variety of connective tissue disorders. Methotrexate when consumed at low doses for longer periods usually has a very limited side effect profile, however, accidental ingestion of large methotrexate doses is common which can result in a wide variety of adverse effects and can even result in fatal demise.We, unfortunately, relate the incidence of a 75-year-old female, who unintentionally consumed 200mg of methotrexate instead of methylcobalamin because the pharmacist misunderstood the prescription. The patient presented to the Accident and Emergency (A&E) department of Jinnah Hospital, Karachi, with extensive hemorrhagic oral ulcers, maculopapular dermatitis, and inability to swallow, which further progressed to acute renal insufficiency, neutropenic sepsis, and respiratory distress. The patient was managed with leucovorin rescue therapy, intravenous rehydration, urinary alkalinization, neutropenic protocol, and oxygen support given her respiratory distress, and hemodialysis was arranged for her renal insufficiency. However, despite all these measures the patient met an unfortunate fate and expired.Patients should be given accurate dosage directions, detailed textural information, and audio-visual resources. Additionally, symptoms of toxicity should be explained to all patients. Measures should be taken to minimize such unfortunate events in the future.

Prevalence and Comorbidities Among Individuals With Rheumatoid Arthritis in the Saudi Arabian Context

“…First, methotrexate suppresses the immune system, which may increase susceptibility to infections and other immune-related comorbidities [34,35]. Second, long-term methotrexate use has been associated with potential adverse effects, including liver toxicity, bone marrow suppression, and gastrointestinal disturbances, which could contribute to the development or exacerbation of comorbidities [36][37][38]. It is important to note that the relationship between methotrexate and comorbidities is complex and the benefits of medication in controlling RA disease activity often outweigh potential risks.…”