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Development of pancytopenia after single low-dose methotrexate therapy in patients with chronic kidney disease: a review of the literature

İbrahim Akdağ, Alparslan Ersoy
Turkish Journal of Internal Medicine , Volume 2, pp 83-90; doi:10.46310/tjim.766086

Abstract: Methotrexate (MTX) is widely used in the treatment of both rheumatoid arthritis (RA) and psoriatic arthritis (PA) with a side effect of pancytopenia. However, very few cases of severe pancytopenia caused by low-dose MTX therapy have been described in chronic kidney disease. Pancytopenia occurred after using a single dose of MTX in three patients with chronic kidney dysfunction. While one patient died due to sepsis and multiple organ failure, the others recovered. The severity of MTX-inducedpancytopenia in our cases was likely related to the underlyingkidney disease. These cases suggest that uremic patients may develop severe fatal bone marrow toxicity even with a single dose of MTX. Therefore, close blood count monitoring after MTX treatment in this population would be beneficial.
Keywords: Treatment / bone marrow / chronic kidney disease / Arthritis / methotrexate / pancytopenia / single dose / Dose of Mtx

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