Pericarditis Induced by Methotrexate: A Case Report and Literature Review

Abstract

Methotrexate (MTX) is a crucial part of the management of rheumatoid arthritis (RA). Although MTX is generally well tolerated, it is not exempt from adverse effects. The side effects of MTX are diverse, and pericarditis, as demonstrated in our case, is one of the rarest adverse effects. Therefore, it is crucial to rule out common causes of pericarditis, such as infections, malignancies, or other underlying conditions. However, once common causes are excluded, MTX-induced pericarditis should always be considered, and MTX should be discontinued without resumption due to potential relapse. Furthermore, the timing of MTX initiation is not significant; patients may have been on chronic MTX treatment or have recently started it. Moreover, pericarditis secondary to MTX is not exclusive to patients with rheumatological conditions but can also occur in other conditions.

Methotrexate and the Risk of Dementia: A Two-Sample Mendelian Randomization Study

“…High doses of methotrexate induce neurological, hematologic, gastrointestinal, and other systemic toxicities [ 38 ]. Whereas, low doses of methotrexate induce liver diseases such as hepatic fibrosis, gastrointestinal reactions, and skin diseases [ 9 ]. In conclusion, as far as the effectiveness and safety of methotrexate use are concerned, the dosage of the drug, the route of action, and the therapeutic regimen are important influences that cannot be ignored.…”

“…However, the use of methotrexate also carries the potential for adverse effects on a variety of organs and systems, with hematologic and gastrointestinal adverse effects being the most common [ 1 , 3 ]. Its common side effects also include elevated liver enzymes, decreased blood counts, opportunistic infections, dermatologic manifestations, and memory impairment [ 9 , 10 ]. Zorlu et al and Lim et al estimated that the prevalence of hematologic toxicity in methotrexate-treated patients with RA was 3% [ 3 , 11 ].…”

“…Zorlu et al and Lim et al estimated that the prevalence of hematologic toxicity in methotrexate-treated patients with RA was 3% [ 3 , 11 ]. A case report and review of the literature suggests that methotrexate use also has an increased risk of pericarditis in patients with rheumatic or other diseases [ 9 ]. A study by Yamamoto et al [ 12 ] concluded that methotrexate, one of the commonly used chemotherapeutic agents, may induce gastrointestinal mucositis.…”