Fatal Neutropenic Enterocolitis Following Methotrexate Overdose: A Case Report

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

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