Mucocutaneous Ulcerations and Pancytopenia Secondary to Methotrexate Toxicity in a Patient With Rheumatoid Arthritis: A Case Report
ABSTRACT Toxicity from methotrexate overdosing is life threatening condition that requires prompt recognition and early treatment. A 71‐year‐old man from rural Bhutan with diabetes mellitus had symmetrical small joint pain for 3 years associated with early morning stiffness. He was evaluated and dia...
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| Format: | Article |
| Language: | English |
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Wiley
2024-12-01
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| Series: | Clinical Case Reports |
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| Online Access: | https://doi.org/10.1002/ccr3.9638 |
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| author | Thinley Dorji Tshering Penjor Sangay Tenzin Tshering Pedon Sangay Wangchuck Sonam Yangchen |
| author_facet | Thinley Dorji Tshering Penjor Sangay Tenzin Tshering Pedon Sangay Wangchuck Sonam Yangchen |
| author_sort | Thinley Dorji |
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| description | ABSTRACT Toxicity from methotrexate overdosing is life threatening condition that requires prompt recognition and early treatment. A 71‐year‐old man from rural Bhutan with diabetes mellitus had symmetrical small joint pain for 3 years associated with early morning stiffness. He was evaluated and diagnosed with seropositive rheumatoid arthritis in a hospital in neighbouring India. He was initiated on Methotrexate and Hydroxychloroquine. The patient had inadvertently taken Methotrexate 10 mg OD for 2 weeks. Following this, he developed painful ulcers on the lips preventing him from swallowing and ulcers around the corona on the penis. He also had intermittent fever with chills. On examination, he had fluid responsive hypotension and pancytopenia without bleeding manifestations. He was managed with intravenous folinic acid, subcutaneous granulocyte colony stimulating factor and intravenous cloxacillin. He had an uneventful recovery and methotrexate has been restarted following adequate patient education. Education of patient and family members is key in preventing medication errors. Early identification and timely management of methotrexate toxicity is key in preventing mortality. |
| format | Article |
| id | doaj-art-1b455efd0b1d409dbd3af5a59d10b4fb |
| institution | Kabale University |
| issn | 2050-0904 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Clinical Case Reports |
| spelling | doaj-art-1b455efd0b1d409dbd3af5a59d10b4fb2024-12-26T06:30:42ZengWileyClinical Case Reports2050-09042024-12-011212n/an/a10.1002/ccr3.9638Mucocutaneous Ulcerations and Pancytopenia Secondary to Methotrexate Toxicity in a Patient With Rheumatoid Arthritis: A Case ReportThinley Dorji0Tshering Penjor1Sangay Tenzin2Tshering Pedon3Sangay Wangchuck4Sonam Yangchen5Department of Internal Medicine Central Regional Referral Hospital Gelephu BhutanDepartment of Internal Medicine Central Regional Referral Hospital Gelephu BhutanDepartment of Internal Medicine Central Regional Referral Hospital Gelephu BhutanSamdrup Jongkhar Hospital Samdrup Jongkhar BhutanDepartment of Internal Medicine Central Regional Referral Hospital Gelephu BhutanDepartment of Rheumatology Kidu Medical Service Centre Thimphu BhutanABSTRACT Toxicity from methotrexate overdosing is life threatening condition that requires prompt recognition and early treatment. A 71‐year‐old man from rural Bhutan with diabetes mellitus had symmetrical small joint pain for 3 years associated with early morning stiffness. He was evaluated and diagnosed with seropositive rheumatoid arthritis in a hospital in neighbouring India. He was initiated on Methotrexate and Hydroxychloroquine. The patient had inadvertently taken Methotrexate 10 mg OD for 2 weeks. Following this, he developed painful ulcers on the lips preventing him from swallowing and ulcers around the corona on the penis. He also had intermittent fever with chills. On examination, he had fluid responsive hypotension and pancytopenia without bleeding manifestations. He was managed with intravenous folinic acid, subcutaneous granulocyte colony stimulating factor and intravenous cloxacillin. He had an uneventful recovery and methotrexate has been restarted following adequate patient education. Education of patient and family members is key in preventing medication errors. Early identification and timely management of methotrexate toxicity is key in preventing mortality.https://doi.org/10.1002/ccr3.9638adverse drug eventantidotehealth literacyleucovorinmedication errors |
| spellingShingle | Thinley Dorji Tshering Penjor Sangay Tenzin Tshering Pedon Sangay Wangchuck Sonam Yangchen Mucocutaneous Ulcerations and Pancytopenia Secondary to Methotrexate Toxicity in a Patient With Rheumatoid Arthritis: A Case Report Clinical Case Reports adverse drug event antidote health literacy leucovorin medication errors |
| title | Mucocutaneous Ulcerations and Pancytopenia Secondary to Methotrexate Toxicity in a Patient With Rheumatoid Arthritis: A Case Report |
| title_full | Mucocutaneous Ulcerations and Pancytopenia Secondary to Methotrexate Toxicity in a Patient With Rheumatoid Arthritis: A Case Report |
| title_fullStr | Mucocutaneous Ulcerations and Pancytopenia Secondary to Methotrexate Toxicity in a Patient With Rheumatoid Arthritis: A Case Report |
| title_full_unstemmed | Mucocutaneous Ulcerations and Pancytopenia Secondary to Methotrexate Toxicity in a Patient With Rheumatoid Arthritis: A Case Report |
| title_short | Mucocutaneous Ulcerations and Pancytopenia Secondary to Methotrexate Toxicity in a Patient With Rheumatoid Arthritis: A Case Report |
| title_sort | mucocutaneous ulcerations and pancytopenia secondary to methotrexate toxicity in a patient with rheumatoid arthritis a case report |
| topic | adverse drug event antidote health literacy leucovorin medication errors |
| url | https://doi.org/10.1002/ccr3.9638 |
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