Methotrexate
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Methotrexate Various toxicities secondary to methotrexate poisoning following medication error: case report
A 68-year-old man developed pharyngodynia, haematochezia, general malaise, oral and nasal mucositis, thrombocytopenia and bowel perforation secondary to methotrexate poisoning due to daily administration of methotrexate instead of prescribed weekly dose during treatment with methotrexate for reactivation of rheumatoid arthritis. The man, who was awaiting the initiation of abatacept for a recent reactivation of rheumatoid arthritis, was prescribed with oral methotrexate 7.5mg once a week. After 10 days, he started having haematochezia, pharyngodynia and general malaise. Medical examination detected thrombocytopenia, and oral and nasal mucositis. During anamnesis, it was revealed that, he had taken methotrexate 7.5mg daily instead of the suggested once weekly (therapeutic error). The serum concentration of methotrexate was within the normal range. The man was immediately treated with folinic acid and urinary alkalinisation. After 7 days, his condition worsened abruptly. An emergency CT scan showed millimetric gas bubbles suggesting bowel perforation. He underwent an emergency exploratory laparotomy followed by peritoneal toilette and sigma resections. Anatomopathological findings were indicating methotrexate poisoning. Seventeen days following hospitalisation, he was discharged in a good clinical condition. Cirronis M, et al. Bowel perforation due to methotrexate therapeutic error: A case report. Clinical Toxicology 58: 611, No. 6, 2020. Available from: URL: http:// doi.org/10.1080/15563650.2020.1741981 [abstract]
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Reactions 26 Sep 2020 No. 1823
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