Combined acute interstitial pneumonitis and pancytopenia induced by low-dose methotrexate in a hemodialysis patient treated for bullous pemphigoid

Li, Haibo; Liu, Fang; Zhang, Min; Yan, Wenliang; Sang, Hong

doi:10.1590/abd1806-4841.20153692

Cited by 11 publications

(4 citation statements)

References 9 publications

(12 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Out of the patients taking methotrexate, around 3 % of the patients suffer from pancytopenia. This is an example of drug-induced pancytopenia ( Figure 3) [12,18].…”

Section: Recent Cases Reported For Pancytopeniamentioning

confidence: 99%

Herbal approach in the treatment of pancytopenia

Bagwe

Kale

Bhatt

et al. 2017

Journal of Complementary and Integrative Medicine

View full text Add to dashboard Cite

Abstract:Pancytopenia is a health condition in which there is a reduction in the amount of leucocytes, erythrocytes and thrombocytes. If more than one of the blood cells is low then the condition is called as bicytopenia. The pancytopenic condition is observed in treatment of diseased conditions like thalassemia and hepatitis C. Iatrogenically pancytopenia is caused by some antibiotics and anti-HCV drugs. Medical conditions like aplastic anaemia, lymphoma, copper deficiency, and so forth can also cause pancytopenia. Pancytopenia can in turn decrease the immunity of the person and thereby can be fatal. Current therapies for pancytopenia include bone marrow stimulant drugs, blood transfusion and bone marrow transplant. The current therapies are very excruciating and have long-term side-effects. Therefore, treating these condition using herbal drugs is very important. Herbs like wheatgrass, papaya leaves and garlic are effective in treating single lineage cytopenias. The present review is focused on the potential effects of natural herbs for the treatment of pancytopenia.

show abstract

“…Out of the patients taking methotrexate, around 3 % of the patients suffer from pancytopenia. This is an example of drug-induced pancytopenia ( Figure 3) [12,18].…”

Section: Recent Cases Reported For Pancytopeniamentioning

confidence: 99%

Herbal approach in the treatment of pancytopenia

Bagwe

Kale

Bhatt

et al. 2017

Journal of Complementary and Integrative Medicine

View full text Add to dashboard Cite

show abstract

“…A total of 1376 articles were identified after removal of duplicates. In the final analysis, 92 articles were included, including two in vitro experiments (174,175), four animal experiments (176 –179), 84 case reports and case series (24,35,88,90,126,163,170,171,180 –255), one pharmacokinetic modeling study (256), and one observational study (160). Although several articles were designed as pharmacokinetic studies in kidney failure patients (170,190,204,225,242), many participants in these studies developed methotrexate-associated toxicity and were included in case reports.…”

Section: Resultsmentioning

confidence: 99%

“…To compare the relative efficacy of extracorporeal treatments, many publications used the percentage decrease in methotrexate concentrations (44,189,201,212,232,237,240,241). However, this metric has little value unless it is adjusted for kidney function and duration of the extracorporeal treatment because serum concentrations are expected to decrease spontaneously due to endogenous processes.…”

Section: Systematic Reviewmentioning

confidence: 99%

Extracorporeal Treatment for Methotrexate Poisoning

Ghannoum

Roberts

Goldfarb

et al. 2022

CJASN

View full text Add to dashboard Cite

Methotrexate is used in the treatment of many malignancies, rheumatological diseases, and inflammatory bowel disease. Toxicity from use is associated with severe morbidity and mortality. Rescue treatments include intravenous hydration, folinic acid, and, in some centers, glucarpidase. We conducted systematic reviews of the literature following published EXtracorporeal TReatments In Poisoning (EXTRIP) methods to determine the utility of extracorporeal treatments in the management of methotrexate toxicity. The quality of the evidence and the strength of recommendations (either “strong” or “weak/conditional”) were graded according to the GRADE approach. A formal voting process using a modified Delphi method assessed the level of agreement between panelists on the final recommendations. A total of 92 articles met inclusion criteria. Toxicokinetic data were available on 90 patients (89 with impaired kidney function). Methotrexate was considered to be moderately dialyzable by intermittent hemodialysis. Data were available for clinical analysis on 109 patients (high-dose methotrexate [>0.5 g/m2]: 91 patients; low-dose [≤0.5 g/m2]: 18). Overall mortality in these publications was 19.5% and 26.7% in those with high-dose and low-dose methotrexate–related toxicity, respectively. Although one observational study reported lower mortality in patients treated with glucarpidase compared with those treated with hemodialysis, there were important limitations in the study. For patients with severe methotrexate toxicity receiving standard care, the EXTRIP workgroup: (1) suggested against extracorporeal treatments when glucarpidase is not administered; (2) recommended against extracorporeal treatments when glucarpidase is administered; and (3) recommended against extracorporeal treatments instead of administering glucarpidase. The quality of evidence for these recommendations was very low. Rationales for these recommendations included: (1) extracorporeal treatments mainly remove drugs in the intravascular compartment, whereas methotrexate rapidly distributes into cells; (2) extracorporeal treatments remove folinic acid; (3) in rare cases where fast removal of methotrexate is required, glucarpidase will outperform any extracorporeal treatment; and (4) extracorporeal treatments do not appear to reduce the incidence and magnitude of methotrexate toxicity.

show abstract

“…Linear regression models revealed good correlations between MTX clearance and creatinine clearance. There are many case reports of fatal pancytopenia in patients with end stage renal disease on hemodialysis treated with low dose MTX [22][23][24][25][26][27][28], even when the dose was reduced to 5-7.5 mg/week. Since MTX serum levels become undetectable within 24 hours after administration and MTX toxicity will be mediated by the intracellular polyglutamate derivatives with long halftime which are not measurable, the quantitative estimation of serum MTX levels is not helpful for monitoring.…”

Section: Recoverymentioning

confidence: 99%

Untitled

2019

J Rheum Dis Treat

View full text Add to dashboard Cite

Background: Severe MTX (methotrexate) toxicity due to low dose MTX used in rheumatic diseases is rare but linked with a high mortality ranging from 13 to 44%. We analyzed 22 cases with a minimum toxicity of CTC (common toxicity criteria) grade 2, that were admitted to our hospital. Methods:We retrospectively analyzed epidemiological data, the weekly MTX dosage, renal function before and at the beginning of the adverse event, co-medication with influence on MTX toxicity or on renal function and potential other co-factors like infections, as well as the outcome, respectively.Results: 22 patients were involved in the study. Three patients died due to pneumonia, all other patients recovered. The main reason for toxicity was an impaired renal function (82%), either from acute renal failure or from acute on chronic renal failure or chronic renal disease stage 4. In 5 cases a dosing error, mainly with daily instead of weekly MTX intake, was the reason. Only in one case the reason remains unclear.Discussion: An impaired renal function with an estimated glomerular filtration rate (eGFR) of 11-54 ml/min was the main cause for MTX toxicity with dosage errors being the second numerous reasons. Our data are in accordance with previous case series, but the influence of reduced renal function is still higher than in the most reports. One reason might be that most case series took only into account the serum creatinine but not a calculated GFR. Serum creatinine alone underestimates the stage of renal failure in patients with lower muscle mass.

show abstract

Combined acute interstitial pneumonitis and pancytopenia induced by low-dose methotrexate in a hemodialysis patient treated for bullous pemphigoid

Cited by 11 publications

References 9 publications

Herbal approach in the treatment of pancytopenia

Herbal approach in the treatment of pancytopenia

Extracorporeal Treatment for Methotrexate Poisoning

Untitled

Contact Info

Product

Resources

About