Hamid Mohsin, Lashari Bilal, Ahsan Irfan, Micaily Ida, Sarwar Usman, Crocetti Joseph
Department of Internal Medicine, Abington Hospital-Jefferson Health, Abington, PA, USA.
Pulmonary and Critical Care, Abington Hospital-Jefferson Health, Abington, PA, USA.
J Community Hosp Intern Med Perspect. 2018 Jun 12;8(3):149-151. doi: 10.1080/20009666.2018.1466598. eCollection 2018.
Methotrexate (MTX) is a chemotherapeutic synthetic(s) phase cell cycle inhibitor, and its role has evolved as an immunological agent in autoimmune diseases like rheumatoid arthritis, psoriasis, and systemic lupus erythematosus, etc. Trimethoprim-sulfamethoxazole (TS) is one of the most widely prescribed antibiotics commonly used for urinary tract infections, exacerbations of chronic bronchitis, traveler's diarrhea, and pneumocystis pneumonia. Both MTX and TS can have significantly overlapping side effects involving dermatologic, renal, and hematological systems, and the combination of these can be deadly. Our case is about the combination of MTX and TS that leads to mucocutaneous ulceration, leukopenia, and renal insufficiency. The purpose of this case is to increase awareness of potentially significant toxicity from the combination of MTX with TS. MTX: methotrexate; TS: trimethoprim-sulfamethoxazole; ED: emergency department; IV: intravenous; GI: gastrointestinal; NSAIDs: nonsteroidal anti-inflammatory drugs.
甲氨蝶呤（MTX）是一种化疗合成的S期细胞周期抑制剂，其作用已发展成为一种用于类风湿性关节炎、银屑病和系统性红斑狼疮等自身免疫性疾病的免疫制剂。甲氧苄啶-磺胺甲恶唑（TS）是最常用的抗生素之一，常用于治疗尿路感染、慢性支气管炎急性加重、旅行者腹泻和肺孢子菌肺炎。MTX和TS都可能有明显重叠的副作用，涉及皮肤、肾脏和血液系统，两者联用可能致命。我们的病例是关于MTX和TS联用导致黏膜皮肤溃疡、白细胞减少和肾功能不全。本病例的目的是提高对MTX与TS联用可能产生的显著毒性的认识。MTX：甲氨蝶呤；TS：甲氧苄啶-磺胺甲恶唑；ED：急诊科；IV：静脉注射；GI：胃肠道；NSAIDs：非甾体抗炎药。
