A Case of Severe Methotrexate Toxicity: Clinical Insights and Management
Methotrexate (MTX), first synthesised in 1947, originated as a derivative of aminopterin, a medication initially used to treat acute leukaemia in children. It shares similar properties with aminopterin and has since demonstrated remarkable efficacy in managing a wide array of complex dermatological...
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JCDR Research and Publications Private Limited
2025-03-01
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| Series: | Journal of Clinical and Diagnostic Research |
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| Online Access: | https://jcdr.net/articles/PDF/20693/76767_CE[Ra1]_F(SL)_QC_PF1(KrA_SL)_PFA_NC(IS)_PN(IS).pdf |
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| author | Pradnya Diggikar Bhavya Sri Yammanaru Tushar Pancholi Manosri Mandadi R Janani |
| author_facet | Pradnya Diggikar Bhavya Sri Yammanaru Tushar Pancholi Manosri Mandadi R Janani |
| author_sort | Pradnya Diggikar |
| collection | DOAJ |
| description | Methotrexate (MTX), first synthesised in 1947, originated as a derivative of aminopterin, a medication initially used to treat acute leukaemia in children. It shares similar properties with aminopterin and has since demonstrated remarkable efficacy in managing a wide array of complex dermatological and rheumatological conditions. Despite its therapeutic benefits, MTX toxicity, though rare, can lead to severe and potentially fatal consequences. This case report describes a 62-year-old male who developed erythematous lesions over his scalp, face, upper limbs, and torso following an excessive intake of MTX (120 mg/week for one month). The patient exhibited symptoms consistent with severe MTX toxicity, including mucositis, pancytopenia, and neutropenic sepsis. Despite timely initiation of leucovorin rescue therapy, intravenous hydration, urine alkalinisation, and aggressive management of neutropenic sepsis the patient’s condition deteriorated. Respiratory support was provided, but he ultimately succumbed to multi-organ dysfunction, underscoring the challenges associated with managing High-Dose MTX (HDMTX) toxicity. This report highlights the mechanisms of MTX toxicity, including its impact on folate metabolism and cell division, resulting in widespread tissue damage and immunosuppression. It emphasises the critical need for early recognition of toxicity symptoms, such as mucositis and bone marrow suppression, to promptly initiate life-saving interventions. Furthermore, it underscores the importance of patient education on MTX dosing and monitoring to prevent such adverse outcomes, illustrating the necessity for vigilant clinical management in patients receiving MTX therapy. |
| format | Article |
| id | doaj-art-4a4cfbe95c8744edbc2939bf5f56b168 |
| institution | DOAJ |
| issn | 2249-782X 0973-709X |
| language | English |
| publishDate | 2025-03-01 |
| publisher | JCDR Research and Publications Private Limited |
| record_format | Article |
| series | Journal of Clinical and Diagnostic Research |
| spelling | doaj-art-4a4cfbe95c8744edbc2939bf5f56b1682025-08-20T03:05:18ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2025-03-01193010310.7860/JCDR/2025/76767.20693A Case of Severe Methotrexate Toxicity: Clinical Insights and ManagementPradnya Diggikar0Bhavya Sri Yammanaru1Tushar Pancholi2Manosri Mandadi3R Janani4Professor and HOU, Department of General Medicine, Dr. D. Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra, India.Postgraduate Resident, Department of General Medicine, Dr. D. Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra, India.Postgraduate Resident, Department of General Medicine, Dr. D. Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra, India.Postgraduate Resident, Department of Pulmonary Medicine, Dr. D. Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra, India.Postgraduate Resident, Department of General Medicine, Dr. D. Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra, India.Methotrexate (MTX), first synthesised in 1947, originated as a derivative of aminopterin, a medication initially used to treat acute leukaemia in children. It shares similar properties with aminopterin and has since demonstrated remarkable efficacy in managing a wide array of complex dermatological and rheumatological conditions. Despite its therapeutic benefits, MTX toxicity, though rare, can lead to severe and potentially fatal consequences. This case report describes a 62-year-old male who developed erythematous lesions over his scalp, face, upper limbs, and torso following an excessive intake of MTX (120 mg/week for one month). The patient exhibited symptoms consistent with severe MTX toxicity, including mucositis, pancytopenia, and neutropenic sepsis. Despite timely initiation of leucovorin rescue therapy, intravenous hydration, urine alkalinisation, and aggressive management of neutropenic sepsis the patient’s condition deteriorated. Respiratory support was provided, but he ultimately succumbed to multi-organ dysfunction, underscoring the challenges associated with managing High-Dose MTX (HDMTX) toxicity. This report highlights the mechanisms of MTX toxicity, including its impact on folate metabolism and cell division, resulting in widespread tissue damage and immunosuppression. It emphasises the critical need for early recognition of toxicity symptoms, such as mucositis and bone marrow suppression, to promptly initiate life-saving interventions. Furthermore, it underscores the importance of patient education on MTX dosing and monitoring to prevent such adverse outcomes, illustrating the necessity for vigilant clinical management in patients receiving MTX therapy.https://jcdr.net/articles/PDF/20693/76767_CE[Ra1]_F(SL)_QC_PF1(KrA_SL)_PFA_NC(IS)_PN(IS).pdfimmunosuppressionrheumatologyrheumatoid arthritissepsis |
| spellingShingle | Pradnya Diggikar Bhavya Sri Yammanaru Tushar Pancholi Manosri Mandadi R Janani A Case of Severe Methotrexate Toxicity: Clinical Insights and Management Journal of Clinical and Diagnostic Research immunosuppression rheumatology rheumatoid arthritis sepsis |
| title | A Case of Severe Methotrexate Toxicity: Clinical Insights and Management |
| title_full | A Case of Severe Methotrexate Toxicity: Clinical Insights and Management |
| title_fullStr | A Case of Severe Methotrexate Toxicity: Clinical Insights and Management |
| title_full_unstemmed | A Case of Severe Methotrexate Toxicity: Clinical Insights and Management |
| title_short | A Case of Severe Methotrexate Toxicity: Clinical Insights and Management |
| title_sort | case of severe methotrexate toxicity clinical insights and management |
| topic | immunosuppression rheumatology rheumatoid arthritis sepsis |
| url | https://jcdr.net/articles/PDF/20693/76767_CE[Ra1]_F(SL)_QC_PF1(KrA_SL)_PFA_NC(IS)_PN(IS).pdf |
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