J Korean Rheum Assoc.  2000 Mar;7(1):90-94.

A Case of Early Aplastic Anemia due to Low Dose Methotrexate in Rheumatoid Arthritis

• Lee SH
• Kim TO
• Song SH
• Kim SI
• Kwak IS
• Cho GJ
• Rha HY
• Lee EY

Abstract

Low dose methotrexate (MTX) is widely used for treatment of rheumatoid arthritis (RA) due to prompt clinical response, relatively lack of serious side effects, tolerability and simplicity of medication. However, several serious adverse effects have been reported with the use of MTX. The prevalence of hematologic toxicity, including leukopenia, thrombocytopenia, megaloblastic anemia, and pancytopenia, is estimated to be 3% in MTX-treated RA patients. Pancytopenia, which occurs unpredictably, is one of the most serious adverse effects and the prevalence is estimated to be 1.4% and fatal pancytopenia reported to occur in 17% of these patients. Old age, impaired renal function, concurrent infection, hypoalbuminemia, increased mean corpuscular volume of red blood cell, concomitant medication such as trimethoprim-sulfamethoxazole and nonsteroidal antiinflammatory drug, are the risk factors of MTX induced pancytopenia. We experienced a case of fatal MTX induced early aplastic anemia in RA patients who medicated 3 times MTX (7.5mg/weekly, 22.5mg of cumulative dose) refractory to treatment with steroid pulse, recombinant human granulocyte macrophage colony stimulating factor (rhGM-CSF) and immunoglobulin.

Keyword

Methotrexate; Aplastic anemia

MeSH Terms

Anemia, Aplastic*
Anemia, Megaloblastic
Arthritis, Rheumatoid*
Erythrocyte Indices
Erythrocytes
Granulocyte-Macrophage Colony-Stimulating Factor
Humans
Hypoalbuminemia
Immunoglobulins
Leukopenia
Methotrexate*
Pancytopenia
Prevalence
Risk Factors
Thrombocytopenia
Trimethoprim, Sulfamethoxazole Drug Combination
Granulocyte-Macrophage Colony-Stimulating Factor
Immunoglobulins
Methotrexate