2015
DOI: 10.1590/abd1806-4841.20153692
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Abstract: Methotrexate has been widely used for many years in the treatment of a variety of diseases. Acute pneumonitis and bone marrow suppression are very serious side effects in methotrexate treatment. A 48-year-old man with end-stage renal disease undergoing chronic hemodialysis developed combined acute pneumonitis and pancytopenia after a cumulative dose of 20 mg methotrexate for bullous pemphigoid. Continuous renal replacement therapy (CRRT) can effi ciently decrease serum methotrexate concentration. A rapid impro… Show more

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Cited by 10 publications
(4 citation statements)
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“…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%
“…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%
“…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%
“…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%