Misinterpretation of Prescription Leading to Acute Methotrexate Toxicity: An avoidable Accident
Low-dose oral methotrexate (MTX), as used for several dermatological and rheumatological indications, is generally a safe medication. Overdose of MTX may cause acute toxicity, which results in oral mucositis, skin ulceration, and pancytopenia. A 40-year-old man presented with a 3-day history of or...
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| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Liaquat National Hospital and Medical College
2025-02-01
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| Series: | Liaquat National Journal of Primary Care |
| Subjects: | |
| Online Access: | https://journals.lnh.edu.pk/lnjpc/pdf/54167155-e211-47cb-a695-40f4edc48394.pdf |
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| Summary: | Low-dose oral methotrexate (MTX), as used for several dermatological and rheumatological indications, is generally a safe medication.
Overdose of MTX may cause acute toxicity, which results in oral mucositis, skin ulceration, and pancytopenia.
A 40-year-old man presented with a 3-day history of oral mucosal ulceration along with pustular eruption, painful bullae, and skin
erosion. He also had a passage of black, tarry stool for 2 days. Another patient, A 50-year-old female presented with oral mucosal
ulceration and per-rectal bleeding. Both were recently started on low-dose oral MTX for seronegative arthritis. Misinterpreting the
physician’s prescription, they took MTX daily instead of weekly. Their blood count revealed a variable degree of pancytopenia. They
were treated with intravenous or oral Leucovorin, along with other supportive therapy. Patients started responding within a few days
after treatment and were discharged after a week.
Proper education of the patient regarding the dosage is fundamental for prescribing MTX and reducing the chance of developing
toxicities. MTX-induced acute toxicity is a medical emergency requiring prompt and proper intervention. |
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| ISSN: | 2707-3521 2708-9134 |