Fatal Manifestations of Methotrexate Overdose in Case of Psoriasis Due to Dosing Error

Nimkar, Shubham V; Yelne, Pallavi; Gaidhane, Shilpa; Acharya, Sourya; Kumar, Sunil

doi:10.7759/cureus.30041

Cited by 5 publications

(1 citation statement)

References 11 publications

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“…Glucarpidase is authorized to treat MTX toxicity when it's above one μmol/L in patients of RA who have nephropathy [ 4 ]. Patients are advised to follow up and monitor laboratory investigations every three months after six months of starting MTX [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

From Treatment to Tragedy: Severe Methotrexate Toxicity With Mucocutaneous Ulcers, Myelosuppression, and Nephropathy

Sawant,

Chaudhari,

Bardiya

et al. 2024

Cureus

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Methotrexate (MTX) is a well-established drug for the use of various neoplastic disorders. Recently, it has been widely used as a disease-modifying antirheumatic drug (DMARD) in low doses, mainly for rheumatoid arthritis (RA) and psoriasis. The drug is known to cause renal damage as well as be excreted via the kidneys, thus causing a higher incidence of adverse effects in patients with impaired renal function. The side effects of MTX toxicity range from mucocutaneous ulcers to nephrotoxicity and bone marrow depression, all of which are seen in this case. Here, we report an elderly male in his late 60s who was prescribed MTX 15 mg once a week along with folic acid 5 mg for RA by a general practitioner. Despite being prescribed once weekly, he continued to take MTX daily without following up with a physician for a span of five months. Following this, he presented to the medicine outpatient department with odynophagia due to oral ulcers for 10 days. He was diagnosed with MTX toxicity, causing nephropathy, myelosuppression, and mucocutaneous ulcerations. He was treated with injectable leucovorin 100 mg thrice a day until the toxicity subsided, leading to his eventual recovery.

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Section: Discussionmentioning

confidence: 99%

From Treatment to Tragedy: Severe Methotrexate Toxicity With Mucocutaneous Ulcers, Myelosuppression, and Nephropathy

Sawant,

Chaudhari,

Bardiya

et al. 2024

Cureus

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Mucocutaneous Ulcerations and Pancytopenia Secondary to Methotrexate Toxicity in a Patient With Rheumatoid Arthritis: A Case Report

Dorji,

Penjor,

Tenzin

et al. 2024

Clinical Case Reports

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Toxicity from methotrexate overdosing is life threatening condition that requires prompt recognition and early treatment. A 71‐year‐old man from rural Bhutan with diabetes mellitus had symmetrical small joint pain for 3 years associated with early morning stiffness. He was evaluated and diagnosed with seropositive rheumatoid arthritis in a hospital in neighbouring India. He was initiated on Methotrexate and Hydroxychloroquine. The patient had inadvertently taken Methotrexate 10 mg OD for 2 weeks. Following this, he developed painful ulcers on the lips preventing him from swallowing and ulcers around the corona on the penis. He also had intermittent fever with chills. On examination, he had fluid responsive hypotension and pancytopenia without bleeding manifestations. He was managed with intravenous folinic acid, subcutaneous granulocyte colony stimulating factor and intravenous cloxacillin. He had an uneventful recovery and methotrexate has been restarted following adequate patient education. Education of patient and family members is key in preventing medication errors. Early identification and timely management of methotrexate toxicity is key in preventing mortality.

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Role of Vitamin C on methotrexate-induced nephrotoxicity in psoriasis context: A preclinical assessment

Díaz-de-la-Cruz,

Hurtado-Nuñez,

Sánchez-Ceja

et al. 2024

Toxicology Reports

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Fatal Manifestations of Methotrexate Overdose in Case of Psoriasis Due to Dosing Error

Cited by 5 publications

References 11 publications

From Treatment to Tragedy: Severe Methotrexate Toxicity With Mucocutaneous Ulcers, Myelosuppression, and Nephropathy

From Treatment to Tragedy: Severe Methotrexate Toxicity With Mucocutaneous Ulcers, Myelosuppression, and Nephropathy

Mucocutaneous Ulcerations and Pancytopenia Secondary to Methotrexate Toxicity in a Patient With Rheumatoid Arthritis: A Case Report

Role of Vitamin C on methotrexate-induced nephrotoxicity in psoriasis context: A preclinical assessment

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