Fatal pancytopenia in a hemodialysis patient after treatment with low-dose methotrexate.

Kitty Kit Ting Cheung, Kai Ming Chow, Cheuk Chun Szeto, Morris Hok Leung Tai, Bonnie Ching Ha Kwan, Philip Kam Tao Li

Journal: Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases 2009;15(4):177-80

PMID: 19502905

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Abstract

We report a 56-year-old male hemodialysis patient who developed fatal pancytopenia after treatment with low-dose methotrexate for psoriasis and psoriatic arthropathy. Risk factors identified included impaired renal function, concurrent use of nonsteroidal anti-inflammatory drugs, low serum albumin, and relatively low serum folate level. Literature review found similar risk factors in 12 other cases. Therefore, methotrexate, even as a single dose, should not be used to treat rheumatic conditions in dialysis patients.

Address: Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, SAR, The People's Republic of China.

DOI: 10.1097/RHU.0b013e3181a61f2d

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MeSH Terms: Antirheumatic Agents, Arthritis, Psoriatic, Dermatologic Agents, Dose-Response Relationship, Drug, Fatal Outcome, Humans, Male, Methotrexate, Middle Aged, Pancytopenia, Psoriasis, Renal Dialysis, Renal Insufficiency