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Archives of Medical Science
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vol. 14
Letter to the Editor

Methotrexate-induced pancytopenia in a patient with ectopic pregnancy

Shih-Chieh Shao, Yea-Huei Kao Yang, Po-Shien Chien, Edward Chia-Cheng Lai

Arch Med Sci 2018; 14, 2: 475–476
Online publish date: 2016/03/23
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Methotrexate (MTX) has been used as the primary treatment for ectopic pregnancies; however; it raises the risk of a life-threatening adverse drug reaction such as pancytopenia [1]. We present a case of MTX-induced pancytopenia in a patient with ectopic pregnancy, which may be idiosyncratic and perhaps unavoidable, and we identify a few early signs of MTX toxicity that might assist in monitoring in order to minimize unintended consequences in patients.
A 27-year-old woman (gravida 2 and para 1), whose body surface area was 1.46 kg/m2, presented without contributory medical history. She was diagnosed with ectopic pregnancy based on the findings of an ultrasound scan (ectopic mass: 1.9 cm) and hCG titer (1774.8 mIU/ml). In pre-treatment evaluations, hemoglobin (Hb: 13.1 g/dl), white blood cells (WBC: 7.72 × 109/l), platelet count (262 × 109/l), blood urea nitrogen (8 mg/dl), serum creatinine (0.51 mg/dl), aspartate aminotransferase (11 U/l), and alanine aminotransferase (11 U/l) were in the normal range. She was subsequently administered a single dose of 50 mg MTX intramuscularly; however, on day 4 after MTX initiation she presented with severe vomiting and mucositis, which limited her daily dietary intake. On day 6, she went to the emergency service due to fever (39.3°C). Although her vital signs were stable (blood pressure: 103/66 mm Hg, pulse rate: 91 beats/min, respiratory rate: 20 breaths/min), hematological assessment revealed febrile neutropenia (WBC: 0.7 × 109/l, neutrophils: 27.0%, Hb: 11.5 g/dl; platelet count: 174 × 109/l). She received a granulocyte colony-stimulating factor agent (filgrastim 300 µg/day) and an empiric broad-spectrum antibiotic for febrile neutropenia. Because her prior complete blood counts were normal, we suspected MTX as the likely cause of neutropenia. She started leucovorin 120 mg/day as a rescue therapy on day 7, but anemia (nadir of Hb was 8 g/dl on day 10; hematocrit: 23.5%; mean cell volume: 92.2 fl) and thrombocytopenia (nadir of platelet count was 11 × 109/l on day 12) were found on the following days. Although bone marrow evaluations were indicated to rule out malignancy and myelodysplasia, the patient did not accept a biopsy. She was transfused with blood products including packed red blood cells and platelets. Her hematologic parameters returned to the normal range and her condition improved gradually after 3 weeks from admission.
Pancytopenia has been reported in 3% of patients with rheumatoid...

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Practice Committee of American Society for Reproductive Medicine. Medical treatment of ectopic pregnancy: a committee opinion. Fertil Steril 2013; 100: 638-44.
Lim AY, Gaffney K, Scott DG. Methotrexate-induced pancytopenia: serious and under-reported? Our experience of 25 cases in 5 years. Rheumatology 2005; 44: 1051-5.
Gungorduk K, Asicioglu O, Yildirim G, Gungorduk OC, Besimoglu B, Ark C. Comparison of single-dose and two-dose methotrexate protocols for the treatment of unruptured ectopic pregnancy. J Obstet Gynaecol 2011; 31: 330-4.
Isaacs JD Jr, McGehee RP, Cowan BD. Life-threatening neutropenia following methotrexate treatment of ectopic pregnancy: a report of two cases. Obstet Gynecol 1996; 88: 694-6.
Kelly H, Harvey D, Moll S. A cautionary tale: fatal outcome of methotrexate therapy given for management of ectopic pregnancy. Obstet Gynecol 2006; 107: 439-41.
Willner N, Storch S, Tadmor T, Schiff E. Almost a tragedy: severe methotrexate toxicity in a hemodialysis patient treated for ectopic pregnancy. Eur J Clin Pharmacol 2014; 70: 261-3.
Sosin M, Handa S. Low dose methotrexate and bone marrow suppression. BMJ 2003; 326: 266-7.
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