Document Type
Event
Location
LSU Health Science Center - New Orleans
Event Website
https://www.medschool.lsuhsc.edu/DOM/Education/researchday/default.aspx
Start Date
4-2024 12:00 AM
End Date
4-2024 12:00 AM
Description
Methotrexate toxicity: The Systemic Impact on the Human Body
Asad Mussarat, MD; Luke Yesbeck, DO; Angus Harper, MD; Ahmed Fazal-ur-rehman, Rebecca Maitski, Seth Vignes, MD; Brian Mackel, MD
Case study: Patient is a 74-year-old female with a past medical history of psoriatic arthritis, recent right above knee amputation, and recurrent UTIs who presented with chief complaint of urinary incontinence and generalized weakness for 5 months. She had multiple UTIs within the 5-month period treated with cephalexin. For the past month, she began having watery diarrhea with both bright red blood and melena in her stools, nausea, and vomiting. She later developed dysphagia and odynophagia one week prior to admission. She also reported bleeding from her gums, and slowly healing abrasions on her upper extremities from a fall one week prior. Patient’s medications include methotrexate, and hydroxychloroquine for seven years. Nonscrapable leukoplakia was present on the surface of her tongue, and mucosal injuries were appreciated on the upper and lower lip. The left lower extremity was warm and erythematous while her right lower extremity amputation site showed purulent, poorly healing wounds. Vitals were stable. Complete blood count was pertinent for WBC of 0.7 x 10^3/uL, hemoglobin 8.8 gm/dL, hematocrit 26.9%, and a platelet 21x10^3/uL. AST and ALT were mildly elevated with 41 U/L and 50 U/L, respectively. The ferritin level was 955 ng/mL (reference 7.3-270.7) and Creactive protein was 19.1 mg/dL. The reticulocyte count was 0.59 %, and folic acid levels were 2.9 ng/mL (>5.4 ng/mL). Methotrexate (MTX) levels were
Discussion: Methotrexate toxicity encompasses a broad spectrum of adverse effects ranging from gastrointestinal symptoms to life-threatening complications such as myelosuppression. The incidence of MTX toxicity varies depending on factors such as pharmakinetics, concomitant medications, and individual patient characteristics. The pathophysiology of MTX toxicity involves interference with folate metabolism, leading to impaired DNA synthesis and cell proliferation. Folate supplementation mitigates these effects by providing a substrate for essential cellular processes, thereby reducing the risk of adverse events. Close monitoring of serum MTX levels and renal function guides treatment decisions, with consideration given to dose adjustment or drug discontinuation in severe cases.
Conclusion: Methotrexate toxicity is a potentially life-threatening complication of MTX therapy that requires prompt recognition and intervention. Clinicians should be vigilant for signs and symptoms of toxicity, particularly in patients with risk factors predisposing to adverse drug regarding the importance of folate supplementation and regular follow-up is essential for optimizing therapeutic outcomes and minimizing the risk of MTX toxicity
Recommended Citation
Musserat, Assad, "Methotrexate toxicity: The Systemic Impact on the Human Body" (2024). Medicine Research Day. 42.
https://digitalscholar.lsuhsc.edu/mrd/2024mrd/mrdposters/42
Methotrexate toxicity: The Systemic Impact on the Human Body
LSU Health Science Center - New Orleans
Methotrexate toxicity: The Systemic Impact on the Human Body
Asad Mussarat, MD; Luke Yesbeck, DO; Angus Harper, MD; Ahmed Fazal-ur-rehman, Rebecca Maitski, Seth Vignes, MD; Brian Mackel, MD
Case study: Patient is a 74-year-old female with a past medical history of psoriatic arthritis, recent right above knee amputation, and recurrent UTIs who presented with chief complaint of urinary incontinence and generalized weakness for 5 months. She had multiple UTIs within the 5-month period treated with cephalexin. For the past month, she began having watery diarrhea with both bright red blood and melena in her stools, nausea, and vomiting. She later developed dysphagia and odynophagia one week prior to admission. She also reported bleeding from her gums, and slowly healing abrasions on her upper extremities from a fall one week prior. Patient’s medications include methotrexate, and hydroxychloroquine for seven years. Nonscrapable leukoplakia was present on the surface of her tongue, and mucosal injuries were appreciated on the upper and lower lip. The left lower extremity was warm and erythematous while her right lower extremity amputation site showed purulent, poorly healing wounds. Vitals were stable. Complete blood count was pertinent for WBC of 0.7 x 10^3/uL, hemoglobin 8.8 gm/dL, hematocrit 26.9%, and a platelet 21x10^3/uL. AST and ALT were mildly elevated with 41 U/L and 50 U/L, respectively. The ferritin level was 955 ng/mL (reference 7.3-270.7) and Creactive protein was 19.1 mg/dL. The reticulocyte count was 0.59 %, and folic acid levels were 2.9 ng/mL (>5.4 ng/mL). Methotrexate (MTX) levels were
Discussion: Methotrexate toxicity encompasses a broad spectrum of adverse effects ranging from gastrointestinal symptoms to life-threatening complications such as myelosuppression. The incidence of MTX toxicity varies depending on factors such as pharmakinetics, concomitant medications, and individual patient characteristics. The pathophysiology of MTX toxicity involves interference with folate metabolism, leading to impaired DNA synthesis and cell proliferation. Folate supplementation mitigates these effects by providing a substrate for essential cellular processes, thereby reducing the risk of adverse events. Close monitoring of serum MTX levels and renal function guides treatment decisions, with consideration given to dose adjustment or drug discontinuation in severe cases.
Conclusion: Methotrexate toxicity is a potentially life-threatening complication of MTX therapy that requires prompt recognition and intervention. Clinicians should be vigilant for signs and symptoms of toxicity, particularly in patients with risk factors predisposing to adverse drug regarding the importance of folate supplementation and regular follow-up is essential for optimizing therapeutic outcomes and minimizing the risk of MTX toxicity
https://digitalscholar.lsuhsc.edu/mrd/2024mrd/mrdposters/42