• Med. J. Aust. · Oct 1991

    Case Reports

    Pancytopenia after accidental overdose of methotrexate. A complication of low-dose therapy for rheumatoid arthritis.

    • M A Brown and A B Corrigan.
    • Rheumatology Department, Repatriation General Hospital Concord, NSW.
    • Med. J. Aust. 1991 Oct 7; 155 (7): 493-4.

    ObjectivePancytopenia is an unusual complication of low-dose methotrexate therapy in rheumatoid arthritis. We report a near fatal case that followed an accidental overdose.Clinical FeaturesAn 80-year-old Caucasian woman with rheumatoid arthritis presented with pancytopenia and severe mucositis. She had taken her weekly methotrexate dose on four sequential days, due to an error in filling a "Dosette" box.Intervention And OutcomeFollowing treatment with piperacillin, gentamicin and folinic acid, she recovered completely.ConclusionsLow-dose methotrexate therapy is uncommonly associated with haematological toxicity. This generally occurs in patients with known risk factors for such reactions. Patient reliability should be considered if methotrexate therapy is contemplated.

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