View Article

Abstract

Methotrexate (MTX) has an antiproliferative, anti-inflammatory, immunomodulatory, and immunosuppressive activity which is used in the treatment of many diseases such as Rheumatoid arthritis (RA), psoriasis, vasculitis, systemic lupus erythematosus, connective tissue diseases. This report describes the 2 cases of MTX-induced pancytopenia. Case 1; A 60-year-old female was having C/o loose motion 5-7 episodes for 2 days, severe generalized weakness, dark colour stool, itchy rashes over the body, cheeks, inside the mouth, and buccal mucosa with RA, and was taking Tablet (Tab) Methotrexate 5 Mg on Saturday and Sunday, Tab Folic Acid 5mg once a day Monday to Friday for 3 months. The patient did not have a proper outpatient monitor of blood investigation resulting in toxicity. She was hospitalized, MTX withdrawn, and treated with folinic acid. Case 2; A 76 years male was admitted to Bombay port trust hospital with a chief complaint of bleeding from the groin region associated with burning, itching, pain, foul smell with skin maceration over the scrotum and penis, low back pain, severe generalized weakness, increased frequency of urination. The patient was case psoriasis on methotrexate for 1 year without a monitor of CBC, kidney, or liver function tests and had taken it continuously resulting in toxicity. He was hospitalized, MTX withdrawn, and treated symptomatically. Our case highlights the importance of counselling to ensure adherence to the correct MTX treatment regimen to prevent toxicity and its serious effects and a new alternative therapeutic method to treat autoimmune disease without measuring side effects and toxicity.

Keywords

Methotrexate, Overdose, Psoriasis, Pancytopenia, Rheumatoid arthritis

Reference

  1. Saigal S, Singh RK, Poddar B. Acute methotrexate toxicity presenting as multiorgan failure and acute pneumonitis: A rare case report. Indian J Crit Care Med. 2012; 16:225-7.
  2. Ann Young, Daniel Beriault, Benjamin Jung, Anna Nikonova, Dory Abosh, Samantha Lee, Jeff Zaltzman, and Jeffrey Perl. DAMPAned Methotrexate: A Case Report and Review of the Management of Acute Methotrexate Toxicity. Canadian Journal of Kidney Health and Disease Volume. 2019; 6:1–6. DOI: 10.1177/2054358119895078.
  3. Yosra Bedoui, Xavier Guillot, Jimmy Sélambarom, Pascale Guiraud, Claude Giry, Marie Christine Jaffar-Bandjee, Stéphane Ralandison, Philippe Gasque. Review Methotrexate an Old Drug with New Tricks. Int. J. Mol. Sci. 2019; 20:5023. doi:10.3390/ijms20205023.
  4. Ansari Umme Ammara Maqbool Ahmad et al. Etiopathogenesis and management of Waja‘al-maf??il (Rheumatoid arthritis): An evidence-based comprehensive review. Int. J. Res. Ayurveda Pharm. 2021;12(6):96-103. http://dx.doi.org/10.7897/2277- 4343.1206180.
  5. Fernando Gonzalez-Ibarra, Sahar Eivaz-Mohammadi, Shiri Surapaneni, Hazem Alsaadi, Amer K. Syed, Simon Badin, Valentin Marian, Mazhar Elamir. Case Report Methotrexate Induced Pancytopenia. Case Reports in Rheumatology. Volume 2014; Article ID 679580,1-4. http://dx.doi.org/10.1155/2014/679580 
  6. Pankti Jariwala, Vinay Kumar, Khyati Kothari, Sejal Thakkar, Dipak Dayabhai Umrigar. Case Report Acute Methotrexate Toxicity: A Fatal Condition in Two Cases of Psoriasis. Case Reports in Dermatological Medicine. Volume 2014; Article ID 946716, 3 pages. http://dx.doi.org/10.1155/2014/946716 
  7. S. Gutierrez-Urena, J. F. Molina, C. O. Garcia, et al., "Pancytopenia secondary to MTX therapy in rheumatoid arthritis," Arthritis and Rheumatism, 1996; vol. 39, pp. 272–276.
  8. Faiza Khatoon, Mohd Azahar, Arzeena Jabeen, Qamar Uddin, Nazim Husain, Mohammed Abdul Rasheed Naikodi. Treatment of chronic plaque psoriasis with herbal Unani formulations: A randomized control trial of efficacy and safety. Journal of Ethnopharmacology. 2022; Volume296,1154-56. ISSN 0378-8741. Doi: org/10.1016/j.jep.2022.115456.
  9. R S Verma, P Khan, S Ayub, S Afzal, J Akhtar, S Ahmad, A A Khan. Efficacy and safety of an Unani compound drug– Habb-e-Asgand in Waja‘al-Maf?sil (Rheumatoid Arthritis) cases- A preliminary study. Indian Journal of Traditional Knowledge. 2021; Vol 20(1), pp 8-14. http://op.niscair.res.in/index.php/IJTK/article/view/27232

Photo
Abdullah Ismail Bhoraniya
Corresponding author

Mumbai port trust hospital, Wadala east, Mumbai, Maharashtra- 400037.

Photo
Asad Sayyed
Co-author

Mumbai port trust hospital, Wadala east, Mumbai, Maharashtra- 400037.

Photo
Surekha Hoskeri
Co-author

Mumbai port trust hospital, Wadala east, Mumbai, Maharashtra- 400037.

Abdullah Ismail Bhoraniya*, Asad Sayyed, Surekha Hoskeri, Methotrexate Induced Pancytopenia In A Patient With Rheumatoid Arthritis And Psoriasis: A Case Report, Int. J. in Pharm. Sci., 2023, Vol 1, Issue 5, 268-273. https://doi.org/10.5281/zenodo.7958450

More related articles
Investigation of the Protective Effect of Fluvoxam...
Chandani Nigam, Dr. Dharmaveer Panjawani , Ashirvad Jaiswal, Saks...
Mycoplasma Pneumonia Induced Stevens-Johnson Syndr...
Biswajit Haldar, Ribul Ahmed, Chetan Gingiri, Praveen Kumar, ...
Assessment Of Incidence & Pattern of Drug Induced ...
Binu KM, H. Doddayya, Praise Marin Sabbu, Sagnik Ghosh, Nimesh Go...
Sitagliptin Induced Bullous Pemphigoid - A Rare Case Report...
Gounak Sankar Mal, Biswajit Haldar, Aniket Saha, Shaikh Ashfaq Ashraf, Dr. K Jagadeesh, Dr. Brunda M...
Ameliorative Effects of Herbal Composite Teas on Aluminium Chloride-Induced Toxi...
Toluwase Solomon Olawuyi, Joseph A. Adeyemi, Idowu Sunday Oyeleye, Babatunde Oluwaseun Ibitoye, Ruka...
Related Articles
Therapeutic Nutrition in Hypertension: A Systems-Biology Perspective on Diet-Ind...
Asha Siddabhovi, Shobha Rajanna, Sreelakshmi Veerendra, Shashikala Krishnamurthy, Rachana Giriswamy,...
Assessment of Pharmacological Activity of Anthocephalus cadamba Bark Extract on ...
Omprakash Ukey, Amol Bondre, Dr. Rajesh Mujariya, Dr. Manjeet Singh, Tejswini Rinahyat, ...
Glucocorticoid-Induced Osteoporosis: Current Treatments and the Promise of Herba...
Sanika Patil, Avantika Lokare, Gajanan Patil, Aajit Patil, ...
Preclinical Evaluation of Eclipta Alba Against Curdlan Induced Spondyloarthritis...
Tanvi Patil, Vaishnavi Kumbhar , Dr. Anilkumar Shinde, Aajit Patil, ...
Investigation of the Protective Effect of Fluvoxamine on Cyclophosphamide Induce...
Chandani Nigam, Dr. Dharmaveer Panjawani , Ashirvad Jaiswal, Sakshi Srivastava, ...
More related articles
Investigation of the Protective Effect of Fluvoxamine on Cyclophosphamide Induce...
Chandani Nigam, Dr. Dharmaveer Panjawani , Ashirvad Jaiswal, Sakshi Srivastava, ...
Mycoplasma Pneumonia Induced Stevens-Johnson Syndrome: A Rare Case Report...
Biswajit Haldar, Ribul Ahmed, Chetan Gingiri, Praveen Kumar, ...
Assessment Of Incidence & Pattern of Drug Induced Gastrointestinal Disorder in a...
Binu KM, H. Doddayya, Praise Marin Sabbu, Sagnik Ghosh, Nimesh Godwin Johny, Ahmed Bin Md. Batis, Mu...
Investigation of the Protective Effect of Fluvoxamine on Cyclophosphamide Induce...
Chandani Nigam, Dr. Dharmaveer Panjawani , Ashirvad Jaiswal, Sakshi Srivastava, ...
Mycoplasma Pneumonia Induced Stevens-Johnson Syndrome: A Rare Case Report...
Biswajit Haldar, Ribul Ahmed, Chetan Gingiri, Praveen Kumar, ...
Assessment Of Incidence & Pattern of Drug Induced Gastrointestinal Disorder in a...
Binu KM, H. Doddayya, Praise Marin Sabbu, Sagnik Ghosh, Nimesh Godwin Johny, Ahmed Bin Md. Batis, Mu...