Akhdar Ghida, Akpan Inemesit, Myles Amanda, Atencah Stanley E
Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA.
Anesthesiology, Boston University School of Medicine, Boston, USA.
Cureus. 2024 Jun 30;16(6):e63528. doi: 10.7759/cureus.63528. eCollection 2024 Jun.
Methotrexate (MTX), a commonly used disease-modifying antirheumatic drug, is generally considered safe at low cumulative doses. However, severe pancytopenia can occur even with doses as low as 10 mg, as illustrated by a fatal case in an older adult with chronic kidney disease (CKI) and vitamin B12 deficiency. Despite the low dose and lack of folate supplementation, the patient developed severe mucositis and pancytopenia leading to fatal complications. This case underscores the challenges in diagnosing and managing MTX-induced pancytopenia, especially in patients with comorbidities such as CKI and vitamin B12 deficiency.
甲氨蝶呤（MTX）是一种常用的改善病情抗风湿药，一般认为低累积剂量时是安全的。然而，即使剂量低至10毫克也可能发生严重全血细胞减少，一名患有慢性肾脏病（CKI）和维生素B12缺乏的老年患者的死亡病例就说明了这一点。尽管剂量低且未补充叶酸，但该患者仍出现了严重的黏膜炎和全血细胞减少，导致致命并发症。该病例凸显了诊断和处理MTX诱导的全血细胞减少的挑战，尤其是在患有CKI和维生素B12缺乏等合并症的患者中。
