Yüksek doz metotreksat kullanımına ikincil gelişen gastrointestinal kanama: Olgu sunumu

Yıl 2018, Cilt: 2 Sayı: 2, 151 - 153, 01.05.2018

Ahmet Peker Hakan Yarkıcı Harun Akar

https://doi.org/10.28982/josam.399081

Cited By: 5

Öz

69 yaşında kadın hasta Acil Servis’ e ağrılı oral ülserler ve rektal kanama ile başvurdu. Romatoid artrit (RA) sebebiyle metotreksat (MTX) kullanıyordu ve haftalık tedavi yerine 10 gün boyunca her gün olacak şekilde MTX kullanmıştı. Labaratuvar testlerinde pansitopeni görüldü. Gastrointestinal mukozal hasar birlikteliği ile olan rektal kanaması MTX toksisitesine ve MTX bağımlı trombositopeniye bağlandı. Bu olguda MTX intoksikasyonunun direkt sebebi haftalık kullanım yerine yanlışlıkla günlük olarak kullanım idi. Bu vaka sağlık çalışanları ile yeterli iletişim kurmanın önemini göstermektedir ve MTX’ın haftalık olarak kullanılması gerektiğini vurgulamaktadır. MTX tedavisi başlanacağı zaman detaylı bir şekilde ilacın nasıl kullanılacağı ve hangi yan etkileri oluşturabileceğini anlatmak elzemdir.

Anahtar Kelimeler

Metotreksat, Romatoid artrit, Trombositopeni

Gastrointestinal bleeding secondary to use of high-dose methotrexate: A case report

Öz

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.

Anahtar Kelimeler

Methotrexate, Rheumatoid arthritis, Thrombocytopenia

Kaynakça

• 1. Altındağ Ö, Küçükoğlu B. Intoxication due to high dose methotrexate in a patient with rheumatoid arthritis: a case report. Turk J Rheumatol. 2011;26:58-60.
• 2. Harris ED. Rheumatoid arthritis: pathophysiology and implications for therapy. N Engl J Med. 1990;322(18):1277-89.
• 3. DoanT, Massarotti E. Rheumatoid arthritis: an overview of new and emerging therapies. J Clin Pharmacol. 2005;45:751-62.
• 4. Lee DM, Weinblatt ME. Rheumatoidarthritis. Lancet. 2001;358:903-11.
• 5. Pincus T, Yazici Y, Sokka T, Aletaha D, Smolen J. Methotrexate as the “anchor drug” for the treatment of early rheumatoid arthritis. Clin Exp Rheumatol. 2003;21:179-85.
• 6. Aicardi J. Tumours and vascular disorders. In: Aicardia J, ed. Diseases of the nervous system in childhood. London: Cambridge University Pres. 2nd edition 1998;513-16.
• 7. Wollina U, Ständer K, Barta U. Toxicity of methotrexate treatment in psoriasis and psoriatic arthritis short and long-term toxicity in 104 patients. Clin Rheumatol. 2001;20(6):406-10.
• 8. Widemann BC, Balis FM, Kempf-Bielack B, Bielack S, Pratt CB, Ferrari S, et al. High dose methotrexate induced nephrotoxicity in patients with osteosarcoma. Cancer. 2004;100(10):2222-32.
• 9. Ural AU, Beyan C, Kaptan K, Avcu F, Taştan B, Çetin T, et al. Pancytopenia developed following low-dose methotrexate therapy for psoriasis. Gülhane Tıp Dergisi 2000;42(2):198-9.
• 10. Ohosone Y, Okano Y, Kameda H, Hama N, Matsumura M, Nojima T, et al. Toxicity of low-dose methotrexate in rheumatoid arthritis-clinical characteristics in patients with MTX-induced pancytopenia and interstitial pneumonitis. Ryumachi. 1997;37:16-23.
• 11. Steger CG, Mader RM, Gnant MF, Marosi C, Lenz K, Jakesz R. GM-CSF in the treatment of a patient with severe methotrexate intoxication. J Intern Med. 1993;233:499-502.
• 12. Yoon KH, Ng SC. Early onset methotrexate induced pancytopenia and response to GCSF: a report of two cases. J Clin Rheumatol. 2001;7:17-20.
• 13. Tsukada T, Nakano T, Miyata T, Sasaki S. Life threatening gastrointestinal mucosal necrosis during methotrexate treatment for rheumatoid arthritis. Case Rep. Gastroenterol. 2013;7(3):470–75.