Published: Dec 25, 2023
  
 
     
 
Keywords:
myelosuppression methotrexate toxicity rheumatoid arthritis
  
     
 
   
 
 
 
 
 
 
 
 
 
 
 

 

 
   
 
 
 
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    Home / Archives / Vol. 19 No.2 (2566) : July - December 2023 / Case Report  
 
   
 

Myelosuppression in rheumatoid arthritis patient treated with methotrexate : A case report
   
 
   
   
     
 
Jakkrapop Pongsuwan
Internal medicine department, Chareonkrung Pracharak Hospital, Department of medical services, Bangkok Metropolitan Administration (BMA)
Nichakarn Sirichoompun
Internal medicine department, Chareonkrung Pracharak Hospital, Department of medical services, Bangkok Metropolitan Administration (BMA)
Montakarn Ittiamornlert
Internal medicine department, Chareonkrung Pracharak Hospital, Department of medical services, Bangkok Metropolitan Administration (BMA)

Abstract

Myelosuppression has been known to be an uncommon but life-threatening condition of methotrexate. Methotrexate level has been used for the diagnosis of methotrexate induced myelosuppression. Methotrexate level rapidly declines after cessation.  Therefore, early detection of methotrexate level is important for diagnosing this condition.


This case report presented a 79-year-old female patient with rheumatoid arthritis and hypertension. She had been prescribed with methotrexate 10 mg per week for 6 months without folic acid supplement. The patient had an abnormal bleeding symptom, petechiae, oral ulcer and melena for one month. Laboratory results showed decrease in hemoglobin level, white blood cell and platelet (indicating pancytopenia). The overall symptoms and laboratory investigation indicated the possibility of methotrexate-induced myelosuppression. The laboratory result of methotrexate level was <0.02 μmol/L, therefore, the bone marrow and chromosome study were performed to exclude acute leukemia. However, once methotrexate was discontinued and leucovorin was prescribed for 2 weeks, the overall laboratory results for myelosuppression were improved. Thus, the patient was diagnosed with methotrexate-induced myelosuppression. After methotrexate discontinuation, no laboratory results showed abnormality.

  
     
     
 
    How to Cite  
     
  Pongsuwan, J., Sirichoompun, N., & Ittiamornlert, M. (2023). Myelosuppression in rheumatoid arthritis patient treated with methotrexate : A case report. Journal of Charoenkrung Pracharak Hospital, 19(2), 63–71. Retrieved from https://he02.tci-thaijo.org/index.php/JCP/article/view/261730  
     

 
 
     
     
 
    Issue  
     
  Vol. 19 No. 2 (2566): July - December 2023  

 
 
     
     
 
    Section  
     
  Case Report  

 
 
     
     
     
 

References

สมาคมรูมาติสซั่มแห่งประเทศไทย. แนวเวชปฏิบัติเพื่อการวินิจฉัยและการดูแลรักษา โรคข้ออักเสบรูมาตอยด์ [อินเทอร์เน็ต]. 2557 [เข้าถึงเมื่อ 26 ส.ค. 2565]. เข้าถึงได้จาก:

https://drive.google.com/file/d/1B8sv1jmWU5HanwL1xDVuVeB2rN5d3lth/view

บุษรากร นิลพันธุ์. พิษจากเมทโทรเทร็กเสท (Methotrexate intoxication). จุลสารพิษวิทยา 2557;22:3-6.

Gutiérrez-Ureña S, Molina JF, García CO, Cuéllar ML, Espinoza LR. Pancytopenia secondary to methotrexate therapy in rheumatoid arthritis. Arthritis Rheum 1996;39:272-6.

Morgan SL, Baggott JE, Vaughn WH, Young PK, Austin JV, Krumdieck CL, et al. The effect of folic acid supplementation on the toxicity of low-dose methotrexate in patients with rheumatoid arthritis. Arthritis Rheum 1990;33:9-18.

Boey O, Van Hooland S, Woestenburg A, Van der Niepen P, Verbeelen D. Methotrexate should not be used for patients with end-stage kidney disease. Acta Clin Belg 2006;61:166-9.

Sultan S, Irfan SM, Ashar S. Acute promyelocytic leukemia: a single center study from Southern Pakistan. Asian Pac J Cancer Prev 2015;16:7893-5.

Chen Y, Kantarjian H, Wang H, Cortes J, Ravandi F. Acute promyelocytic leukemia: a population-based study on incidence and survival in the United States, 1975-2008. Cancer 2012;118:5811-8.

Zhao M, Liang L, Ji L, Chen D, Zhang Y, Zhu Y, et al. MTHFR gene polymorphisms and methotrexate toxicity in adult patients with hematological malignancies: a meta-analysis. Pharmacogenomics 2016;17:1005-17.

Hess JA, Khasawneh MK. Cancer metabolism and oxidative stress: insights into carcinogenesis and chemotherapy via the non-dihydrofolate reductase effects of methotrexate. BBA Clin 2015;3:152-61.