Severe bone marrow suppression following single-dose methotrexate treatment for ectopic pregnancy

Yıl 2017, Cilt: 3 Sayı: 3, 285 - 289, 04.11.2017

Betül Dündar , Burcu Dinçgez Çakmak , Gülten Özgen , Fatma Ketenci Gencer Burcu Aydın Boyama

https://doi.org/10.18621/eurj.304373

Öz

Methotrexate is associated with multisystem side
effects which depend on the dosage, route of administration and length of
treatment. Bone marrow suppression is a very rare but one of the most mortal
complications. A case of severe bone marrow suppression following single dose
methotrexate for ectopic pregnancy was presented in this study. A 33-year-old woman,
diagnosed as ectopic pregnancy, was given single-dose intramuscular methotrexate
of 50 mg/m². On 10^th day patient was admitted with lethargy,
irritability, vomiting, hematemesis, diarrhea, oral mucositis and skin rash.
Laboratory findings revealed severe bone marrow suppression. Supportive
treatment together with antibacterial/ antifungal drugs and granulocyte colony
stimulating factors were administered. On the 3^rd day of treatment,
mucositis and oral intake began to improve. After 1 week complete blood count
was normal. Methotrexate may have mortal clinical consequences even with very
low doses. Therefore, a careful patient history for patient selection and
closer clinical follow-up are essential. 

Anahtar Kelimeler

Bone marrow suppression, ectopic pregnancy, methotrexate, side effects, single-dose regimen

Kaynakça

• [1] Boufous S, Quartararo M, Mohsin M, Parker J. Trends in the incidence of ectopic pregnancy in New South Wales between 1990-1998. Aust N Z J Obstet Gynaecol 2001;41:436-8.
• [2] Uğurlucan FG, İyibozkurt AC, Çetin C, Nehir A, Akhan S. [Methotrexate treatment for ectopic pregnancy: Factors affecting treatment outcome]. Ege Tıp Dergisi 2013;52:199-204. [Article in Turkish)
• [3] Skubisz MM, Tong S. The evolution of methotrexate as a treatment for ectopic pregnancy and gestational trophoblastic neoplasia: a review. ISRN Obstet Gynecol 2012;2012:637094.
• [4] Dündar B, Karalök A, Üreyen I, Gündoğdu B, Öçalan R, Turan T, et al. Case report: Methotrexate-induced pericardial effusion. J Turk Ger Gynecol Assoc 2013;14:48-9.
• [5] Stovall TG, Ling FW, Gray LA. Single-dose methotrexate for treatment of ectopic pregnancy. Obstet Gynecol 1991;77:754-7.
• [6] Kirk E, Condous G, Van Calster B, Haider Z, Van Huffel S, Timmerman D, et al. A validation of the most commonly used protocol to predict the success of single-dose methotrexate in the treatment of ectopic pregnancy. Human Reprod 2007;22:858-63.
• [7] Soliman KB, Saleh NM, Omran AA. Safety and efficacy of systemic methotrexate in the treatment of unruptured tubal pregnancy. Saudi Med J 2006;27:1005-10.
• [8] Sivalingam VN, Duncan WC, Kirk E, Shephard LA, Horne AW. Diagnosis and management of ectopic pregnancy. J Fam Plann Reprod Health Care 2011;37:231-40.
• [9] Dasari P, Sagili H. Life-threatening complications following multidose methotrexate for medical management of ectopic pregnancy. BMJ Case Rep 2012;2012:bcr0320126023.
• [10] Faganel Kotnik B, Grabnar I, Bohanec Grabar P, Dolzan V, Jazbec J. Association of genetic polymorphism in the folate metabolic pathway with methotrexate pharmacokinetics and toxicity in childhood acute lymphoblastic leukaemia and malignant lymphoma. Eur J Clin Pharmacol 2011;67:993-1006.
• [11] Santucci R, Levêque D, Herbrecht R. Cola beverages and delayed elimination of methotrexate. Br J Clin Pharmacol 2010;70:762-4.
• [12] Isaacs JD, McGehee RP, Cowan BD. Life-threatening neutropenia following methotrexate treatment of ectopic pregnancy: a report of two cases. Obstet Gynecol 1996;88:694-6.
• [13] Stoller RG, Hande KR, Jacobs SA, Rosenberg SA, Chabner BA. Use of plasma kinetics to predict and prevent methotrexate toxicity. N Eng J Med 1977;297:630-4.