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

(6 citation statements)

References 9 publications

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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%

Herbal approach in the treatment of pancytopenia

Bagwe

Kale

Bhatt

et al. 2017

Journal of Complementary and Integrative Medicine

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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.

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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%

Herbal approach in the treatment of pancytopenia

Bagwe

Kale

Bhatt

et al. 2017

Journal of Complementary and Integrative Medicine

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“…Studies have shown the effectiveness of corticosteroids in managing BP, even in complex cases like post-transplant recipients or in patients experiencing kidney transplant rejection ( 35 , 41 ). Among 59 reported cases using corticosteroids, 14 (23.73%) patients were recalcitrant ( 23 , 25 , 37 , 44 , 46 , 48 , 50 , 52 , 62 , 67 – 70 ). The dosage of corticosteroids was reported in twenty-two cases who responded well.…”

Section: Resultsmentioning

confidence: 99%

Pemphigoid diseases in patients with end-stage kidney diseases: pathogenesis and treatment

Yang,

Wang,

Zuo

2024

Front. Immunol.

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BackgroundPemphigoid diseases constitute a group of autoimmune blistering disorders characterized by subepithelial blistering. The association between pemphigoid diseases and both end-stage kidney disease (ESKD) and its treatment is notable. However, there is limited evidence about the management of pemphigoid diseases in patients with ESKD. This systematic review compiled case reports and relevant studies, summarized the underlying mechanisms of pemphigoid diseases in patients with ESKD, and summarized the efficacy of various therapies.MethodsA systematic search of PubMed and Embase was performed for articles published between 1982 to June 2, 2024.ResultsFifty-three case reports and eight relevant studies were included. Triggers for pemphigoids in patients with ESKD included materials used to treat ESKD, immune dysregulation of patients with ESKD, and rejection of renal allograft. Treatment for these patients included removing triggers, as well as administering of corticosteroids, mycophenolate mofetil (MMF), tetracyclines, rituximab, methotrexate, dapsone, azathioprine, cyclosporine, intravenous immunoglobin (IVIG), plasmapheresis, and Janus kinase inhibitors.ConclusionRemoving triggers is the most effective strategy. Despite their suboptimal efficacy, corticosteroids remain the most commonly used agents in this patient population. MMF, tetracyclines, and rituximab are less used but with benefits. There are significant adverse effects associated with methotrexate treatment. Other treatment may also be beneficial and require further investigation. These findings may enable clinicians to optimize the therapeutic approach for these patients.

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“…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

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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.

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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

Pemphigoid diseases in patients with end-stage kidney diseases: pathogenesis and treatment

Extracorporeal Treatment for Methotrexate Poisoning

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