Department of Obstetrics and Gynecology, Beijing Friendship Hospital, Beijing, China.
J Med Case Rep. 2023 Apr 2;17(1):119. doi: 10.1186/s13256-023-03834-z.
Methotrexate is an anticancer drug from the antimetabolite class. It is also used in gynecology and obstetrics for the medical treatment of ectopic pregnancies. Low-dose methotrexate-induced adverse toxic effects are rare. We report a case of toxic effect associated with severe renal insufficiency induced by LD-MTX (Low-Dose Methotrexate) for ectopic pregnancy.
A 46-year-old Chinese woman was in an operation for an ectopic pregnancy of tubal interstitial pregnancy. The embryo villus was so little that we were not sure if it was evacuated, then it was followed with 50 mg methotrexate injection of intramuscular adjacent the uterine horn in the operation. 48 hour later after injection the patient presented with renal failure. The personalized genetic testing showed that MTHFR (677C > T) and ABCB1 (3435T > C) were detected. Gradually, the symptoms improved after calcium leucovorin (CF) rescue, continuous renal replacement therapy (CRRT), promoting blood system regeneration, and multiple supportive treatments.
When toxic effects are suspected, detecting the polymorphisms of an MTHFR gene and monitoring MTX concentration in blood could assist us to formulate individualized and active treatments. The management should be multidisciplinary and as much as possible within an intensive care unit.
甲氨蝶呤是一种抗代谢类抗癌药物。它也在妇产科中用于治疗异位妊娠。低剂量甲氨蝶呤引起的不良毒性作用较为罕见。我们报告了一例因低剂量甲氨蝶呤（LD-MTX）治疗异位妊娠而导致严重肾功能不全的毒性作用病例。
一名 46 岁的中国女性因输卵管间质部妊娠而行手术治疗。胚胎绒毛很少，我们不确定是否已排出，因此在手术中于子宫角旁肌内注射 50mg 甲氨蝶呤。注射后 48 小时，患者出现肾衰竭。个性化基因检测显示 MTHFR（677C>T）和 ABCB1（3435T>C）突变。经钙叶琳（CF）解救、持续肾脏替代治疗（CRRT）、促进血液系统再生和多种支持性治疗后，症状逐渐改善。
当怀疑出现毒性作用时，检测 MTHFR 基因的多态性和监测血液中甲氨蝶呤浓度可以帮助我们制定个体化和积极的治疗方案。管理应多学科进行，并尽可能在重症监护病房内进行。
