Fatal Neutropenic Enterocolitis Following Methotrexate Overdose: A Case Report

Year 2019, , 260 - 262, 30.12.2019

Nevin İnce , Bekir Tunca , Dilek Yekenkurul , Mustafa Yıldırım

https://doi.org/10.18678/dtfd.639211

Cited By: 1

Abstract

Methotrexate, a folic acid antagonist, is widely used in the treatment of neoplasms in addition to diseases such as psoriasis and rheumatoid arthritis. Although well tolerated under normal conditions, the use of more than the recommended doses may cause life-threatening toxicities. Toxicity due to high doses of methotrexate is manifested by bone marrow inhibition, gastrointestinal mucosal damage and pancytopenia. Most cases result from overdose. However, serious adverse events that result in mortality, in particular those of mixing medication in elderly patients, are rare. Herein, we present the case of a 72-year-old man who admitted to the emergency department with painful oral ulcers, inability to swallow and a general impaired condition, and died of sepsis after developing neutropenic enterocolitis following a fever and neutropenia.

Keywords

methotrexate, overdose, pancytopenia, neutropenic enterocolitis

Yüksek Doz Metotreksat Alımı Sonrası Gelişen Fatal Nötropenik Enterokolit: Olgu Sunumu

Abstract

Bir folik asit antagonisti olan metotreksat, psoriazis ve romatoid artrit gibi hastalıklara ek olarak, neoplazmaların tedavisinde yaygın olarak kullanılır. Normal koşullarda iyi tolere edilse de önerilen dozlardan fazla kullanılması hayatı tehdit eden toksikasyonlara neden olabilir. Yüksek doz metotreksat’a bağlı toksisite, kemik iliği inhibisyonu, gastrointestinal mukozal hasar ve pansitopeni ortaya çıkabilir. Çoğu durumda doz aşımı sonucu ortaya çıkar. Bununla birlikte, özellikle yaşlı hastalardaki ilaçları karıştırmak gibi, ölümcül sonuçlanan ciddi yan etkiler daha nadirdir. Burada, acil servise ağrılı oral ülser, yutkunma bozukluğu ve genel durum bozukluğu ile başvuran, ateş ve nötropeninin ardından nötropenik enterokolit geliştikten sonra sepsisten ölen 72 yaşında bir erkek olguyu sunuyoruz.

Keywords

metotreksat, aşırı doz, pansitopeni, nötropenik enterokolit

References

• Altındağ Ö, Küçükoğlu B. Intoxication due to high dose methotrexate in a patient with arthritis: A case report. Turk J Rheumatol. 2011;26(1):58-60.
• Cheng KK. Association of plasma methotrexate, neutropenia, hepatic dysfunction, nausea/vomiting and oral mucositis in children with cancer. Eur J Cancer Care (Engl). 2008;17(3):306-11.
• Romão VC, Lima A, Bernardes M, Canhão H, Fonseca JE. Three decades of low-dose methotrexate in rheumatoid arthritis: Can we predict toxicity? Immunol Res. 2014;60(2-3):289-310.
• Madke B, Singh AL. Acute methotrexate toxicity. Indian J Drugs Dermatol. 2015;1(1):46-9.
• Gutierrez-Ureña S, Molina JF, García CO, Cuéllar ML, Espinoza LR. Pancytopenia secondary to MTX therapy in rheumatoid arthritis. Arthritis Rheum. 1996;39(2):272-6.
• Schlatter M, Snyder K, Freyer D. Successful non operative management of typhlitis in pediatric oncology patients. J Pediatr Surg. 2002;37(8):1151-5.
• 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):470-5.
• Peker A, Yarkıcı H, Akar H. Gastrointestinal bleeding secondary to use of high-dose methotrexate: A case report. J Surg Med. 2018;2(2):151-3.
• Bidaki R, Kian M, Owliaey H, Babaei Zarch M, Feysal M. Accidental chronic poisoning with methotrexate: Report of two cases. Emerg (Tehran). 2017;5(1):e67.
• Isoardi KZ, Harris K, Carmichael KE, Dimeski G, Chan BSH, Page CB. Acute bone marrow suppression and gastrointestinal toxicity following acute oral methotrexate overdose. Clin Toxicol (Phila). 2018;56(12):1204-6.