Ewha Med J.  2023 Apr;46(2):e3. 10.12771/emj.2023.e3.

A Rare Case of Methotrexate Induced Pancreatitis in Ectopic Pregnancy

• Choi J
• Kang M
• Hur YM
• Kim YJ
• Park S

• KMID: 2542122
• DOI: http://doi.org/10.12771/emj.2023.e3

Abstract

Ectopic pregnancy (EP) refers to blastocyst implantation outside the uterine endometrium. EP is major cause of maternal morbidity and mortality. Treatment options include surgery, medical therapy with methotrexate, or expectant management. Methotrexate is the primary regimen used in cases of early, unruptured ectopic pregnancies. Most side effects of methotrexate are minor, including nausea, vomiting, abdominal discomfort, and photosensitive skin reaction. Serious side effects, including bone marrow suppression, and pulmonary fibrosis, are invariably observed when methotrexate is administered in high doses with frequent dosing intervals, in chemotherapeutic protocols for malignancy. These side effects are uncommon with the doses used to treat ectopic pregnancies. Since cases of methotrexate-induced pancreatitis are rare, we report a case of pancreatitis in a patient with EP treated with methotrexate and expect to consider pancreatitis as a side effect of methotrexate in a patient with upper abdominal pain undergoing methotrexate chemotherapy.

Keyword

Pregnancy; ectopic; Methotrexate; Pancreatitis

Figure

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  Fig. 1. Abdominal pelvic CT scan on admission day. (A) Pancreatic parenchyma enhancement by intravenous contrast agent. Acute inflammation of the pancreatic parenchyma and peripancreatic tissue, with stranding of the surrounding fat. (B) Acute peripancreatic fluid collection in the left anterior pararenal space. (C) Acute hematoma (arrow) in the cul-de-sac without active bleeding.

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  Fig. 2. Abdominal sonogram on admission day. (A) Enlarged and swollen of acute pancreatitis (circle) with peripancreatic fluid collection. (B) 1.4 cm anechoic lesion (arrow) around the pancreatic tail, with probable loculated peripancreatic fluid collection.

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  Fig. 3. Transvaginal sonogram on admission. (A) Coronal view of the left adnexa. The thick-walled left adnexa cystic structure, separate from the ovary, called ‘tubal ring sign’, which show unruptured tubal ectopic pregnancy. (B) Hematoma, sized 7.9×3.5 cm2, in posterior cul-de-sac.

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  Fig. 4. Follow-up transvaginal sonogram after treatment. (A) Complex echoic, irregular shaped left adnexa mass, sized 3.2×2.7 cm2. Previously tubal ring sign disappeared and the total size of the mass was decreased. (B) A 5.0×3.1 cm2 hematoma in the posterior cul-de-sac.

Reference

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