Methotrexate/non-steroidal anti-inflammatories/potassium chloride
- PDF / 170,647 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 50 Downloads / 198 Views
1 XS
Methotrexate/non-steroidal anti-inflammatories/potassium chloride Myelosuppression secondary to drug interaction and myometrial pseudoaneurysm: case report
A 34-year-old woman developed myelosuppression following concomitant administration of methotrexate for management of caesarean scar pregnancy (CSP) and unspecified non-steroidal anti-inflammatories for temporomandibular joint pain. Additionally, she developed myometrial pseudoaneurysm secondary to potassium chloride for management of CSP [not all routes stated]. The woman (gravida 3, para 2) had a history of two prior caesarean deliveries. A dating ultrasound scan revealed 7 weeks CSP. She was treated with two doses of systemic methotrexate (low-dose) and two doses of intergestational potassium chloride injection. Her medical history was significant for temporomandibular joint pain, and she had been receiving unspecified non-steroidal antiinflammatories regularly. However, despite proper counselling regarding the potential interaction between unspecified nonsteroidal anti-inflammatories and methotrexate, she continued to use the former for joint pain. Two days following methotrexate treatment, she developed fever and pancytopenia and was transferred to the ICU. Initially, sepsis was presumed. The woman was treated for presumed sepsis. Thereafter, the diagnosis of myelosuppression was confirmed on day 10. Subsequently, she recovered by day 15, and she was discharged. Her myelosuppression was attributed to the pharmacokinetic interaction of methotrexate with unspecified non-steroidal anti-inflammatories leading to the prolongation of half-life of methotrexate. Two weeks later, she presented again with acute vaginal bleeding. An ultrasound revealed possible myometrial pseudoaneurysm in the anterior lower segment of the uterus. A CT scan revealed a 3.4 × 1.5cm pseudoaneurysm and a ruptured CSP with an associated moderate haematoma. In addition to the vascular trauma from local injection of potassium chloride, synctiotrophoblastic tissue and neovascularisation contributed to her pseudoaneurysm. She underwent left uterine artery embolisation; however, her vaginal bleeding continued, and she required bilateral uterine artery embolisation. Her Hb stabilised following embolisation; however, she continued to have peritonitic abdomen, and decided to undergo a total abdominal hysterectomy. The pathology showed a haematoma associated with trophoblastic villi in lower segment. Additionally, an inflammatory reaction associated with endometritis and myometritis were noted. Omand A, et al. Myometrial Pseudoaneurysm and Myelosuppression Following Conservative Management of Cesarean Scar Ectopic Pregnancy. Journal of Obstetrics and 803500239 Gynaecology Canada 42: 798-801, No. 6, Jun 2020. Available from: URL: https://doi.org/10.1016/j.jogc.2019.08.023
0114-9954/20/1821-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 12 Sep 2020 No. 1821
Data Loading...
