Bartha Peter, Bron Rita, Levy Yishai
Department Medicine D, Rambam Medical Center, and Rappaport Faculty of Medicine, Technion, Haifa, Israel.
Harefuah. 2004 Jun;143(6):398-400, 464.
Low dose methotrexate [MTX] is now frequently used for various inflammatory diseases. This is a case study of a fatal outcome in a patient with rheumatoid arthritis [RA] treated for a short period with low dose MTX. The patient developed severe pancytopenia followed by bacterial and monilial sepsis upon the co-administration of trimethoprim-sulphamethoxazole [TMP-SMX] for an intercurrent infection. The differential diagnosis of pancytopenia and the mechanisms underlying the increase in plasma free MTX by MTX-SMX in the patient are discussed. It should be noted that this fatal case highlights the risk of severe drug interactions in patients with multiple risk factors treated with low dose MTX for a short period of time.
低剂量甲氨蝶呤（MTX）目前常用于治疗各种炎症性疾病。本文是一例类风湿关节炎（RA）患者短期使用低剂量MTX治疗后出现致命结局的病例研究。该患者并发感染，在联合使用甲氧苄啶-磺胺甲恶唑（TMP-SMX）后出现严重全血细胞减少，随后发生细菌和念珠菌败血症。文中讨论了全血细胞减少的鉴别诊断以及该患者中MTX-SMX导致血浆游离MTX升高的潜在机制。需要注意的是，这一致命病例凸显了短期使用低剂量MTX治疗的多重危险因素患者发生严重药物相互作用的风险。
