Two Cases of Severe Pancytopenia Associated with Low-Dose Methotrexate Therapy in Patients with Chronic Kidney Disease and Rheumatoid Arthritis / 영남의대학술지
Yeungnam University Journal of Medicine
; : 60-69, 2011.
Article
en Ko
| WPRIM
| ID: wpr-210650
Biblioteca responsable:
WPRO
ABSTRACT
Due to its efficacy and tolerability, low dose oral methotrexate(MTX) therapy has been widely used for treatment of rheumatoid arthritis(RA). However, it can rarely cause serious, life-threatening hematologic toxicities, such as pancytopenia. We report here on two patients with chronic kidney disease(CKD), who developed severe pancytopenia after 5 years (cumulative dose 1,240mg) and 4 years(cumulative dose 1,320mg) of low dose MTX therapy for treatment of RA, respectively. Both patients presented with renal insufficiency, hypoalbuminemia, concurrent use of nonsteroidal anti-inflammatory drugs, and elevated mean corpuscular volume of red blood cells(RBCs), all of which are known as risk factors of MTX-induced pancytopenia. Despite receiving treatment, which included RBC and platelet transfusions, antibiotic therapy, granulocyte colony stimulating factor, and leucovorin rescue, one patient died of sepsis. Based on our case study, prompt investigation of risk factors associated with MTX toxicity is required for all patients receiving MTX therapy. MTX treatment, even at a low dose, should be discontinued in patients with advanced CKD.
Palabras clave
Texto completo:
1
Índice:
WPRIM
Asunto principal:
Pancitopenia
/
Artritis Reumatoide
/
Metotrexato
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Leucovorina
/
Factores de Riesgo
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Factores Estimulantes de Colonias
/
Transfusión de Plaquetas
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Sepsis
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Hipoalbuminemia
/
Índices de Eritrocitos
Tipo de estudio:
Etiology_studies
/
Risk_factors_studies
Límite:
Humans
Idioma:
Ko
Revista:
Yeungnam University Journal of Medicine
Año:
2011
Tipo del documento:
Article