Third Department of Obstetrics and Gynecology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece.
Department of Obstetrics and Gynecology, Democritus University of Thrace, 691 00 Campus, Greece.
Medicina (Kaunas). 2024 Nov 20;60(11):1900. doi: 10.3390/medicina60111900.
: Caesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy in which the early pregnancy implants at the site of the uterine scar. Methotrexate (MTX) in lower doses can be used to treat CSPs. However, MTX administration is associated with a spectrum of side effects that include hematological toxicities. This case report presents a CSP treated with an intragestational injection of MTX and subsequently developed pancytopenia. : A 23-year-old woman at six weeks and six days of pregnancy was referred as a potential case of CSP. After establishing the diagnosis, she was treated with a transvaginal ultrasound-guided intragestational administration of 80 mg MTX (adjusted to 50 mg/m body surface area) under sedation. : On day four after the MTX injection, she developed oral ulcers, fever, and pruritic phlyctenular maculopapular rash. Subsequently, the patient developed febrile neutropenia and was admitted to the Intensive Care Unit. On day six, a subsequent exacerbation of the rash was observed with the formation of blisters and purplish spots with concurrent odynophagia and sialorrhea. Ultimately, the patient developed pancytopenia due to bone marrow suppression. Fifteen days after MTX administration, the patient recovered and was discharged from the hospital hemodynamically stable, afebrile, with dropping β-hcg levels, and in good clinical condition. : Although methotrexate administration is the preferred option for the treatment of cesarean scar pregnancies, clinicians should be aware of the fact that its use entails potential risks, even when it is used locally. To our knowledge, this case is the first description of pancytopenia due to bone marrow suppression following a single low dose of intragestational methotrexate injection.
剖宫产瘢痕妊娠（CSP）是一种罕见的异位妊娠形式，早期妊娠着床于子宫瘢痕部位。低剂量甲氨蝶呤（MTX）可用于治疗 CSP。然而，MTX 给药与一系列副作用相关，包括血液学毒性。本病例报告介绍了一例接受宫腔内 MTX 注射治疗的 CSP 病例，随后发生全血细胞减少症。
一名 23 岁女性，妊娠 6 周零 6 天，被怀疑为 CSP。确诊后，在镇静下经阴道超声引导宫腔内注射 80mg MTX（调整至 50mg/m 体表面积）进行治疗。
MTX 注射后第 4 天，患者出现口腔溃疡、发热和瘙痒性疱疹性红斑丘疹。随后，患者出现发热性中性粒细胞减少症并被收入重症监护病房。第 6 天，皮疹加重，出现水疱和紫色斑点，同时伴有咽痛和流涎。最终，患者因骨髓抑制导致全血细胞减少症。MTX 给药后 15 天，患者恢复并出院，血流动力学稳定，无发热，β-hCG 水平下降，临床状况良好。
尽管甲氨蝶呤给药是治疗剖宫产瘢痕妊娠的首选方案，但临床医生应该意识到，即使局部使用，也存在潜在风险。据我们所知，这是首例宫腔内单次低剂量 MTX 注射后因骨髓抑制导致全血细胞减少症的病例描述。
