Fatal multiorgan dysfunction following repeated iodinated radiocontrast injection in a patient receiving low-dose oral methotrexate -a case report-
Background Methotrexate is an antimetabolite drug that blocks dihydrofolate reductase and impairs cellular DNA synthesis. Administration of intravenous iodinated radiocontrast agents can cause life-threatening toxicity in patients receiving methotrexate. Case A 60-year-old female patient with rheuma...
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| Format: | Article |
| Language: | English |
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Korean Society of Anesthesiologists
2022-06-01
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| Series: | Korean Journal of Anesthesiology |
| Subjects: | |
| Online Access: | http://ekja.org/upload/pdf/kja-22067.pdf |
| _version_ | 1818241768643100672 |
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| author | Balaji Vaithialingam Radhakrishnan Muthuchellappan Mouleeswaran Sundaram |
| author_facet | Balaji Vaithialingam Radhakrishnan Muthuchellappan Mouleeswaran Sundaram |
| author_sort | Balaji Vaithialingam |
| collection | DOAJ |
| description | Background Methotrexate is an antimetabolite drug that blocks dihydrofolate reductase and impairs cellular DNA synthesis. Administration of intravenous iodinated radiocontrast agents can cause life-threatening toxicity in patients receiving methotrexate. Case A 60-year-old female patient with rheumatoid arthritis underwent a craniotomy and clipping of a distal anterior cerebral artery aneurysm. The patient had been on low-dose oral methotrexate for the previous 5 years, which was discontinued two days before surgery. The patient received the first intravenous contrast agent injection (iohexol) during diagnostic cerebral angiography one day prior to surgery (50 ml) and the second contrast dose on the first postoperative day (60 ml). The patient developed severe methotrexate toxicity, leading to fatal multiorgan failure and death following repeated contrast imaging with intravenous iohexol. Conclusions Even though low-dose oral methotrexate has minor adverse effects, life-threatening toxicity can be precipitated in the presence of iodinated contrast agents. |
| first_indexed | 2024-12-12T13:34:35Z |
| format | Article |
| id | doaj.art-71df3e53ae964de8bb63dd4301bd5719 |
| institution | Directory Open Access Journal |
| issn | 2005-6419 2005-7563 |
| language | English |
| last_indexed | 2024-12-12T13:34:35Z |
| publishDate | 2022-06-01 |
| publisher | Korean Society of Anesthesiologists |
| record_format | Article |
| series | Korean Journal of Anesthesiology |
| spelling | doaj.art-71df3e53ae964de8bb63dd4301bd57192022-12-22T00:23:00ZengKorean Society of AnesthesiologistsKorean Journal of Anesthesiology2005-64192005-75632022-06-0175328328510.4097/kja.220678797Fatal multiorgan dysfunction following repeated iodinated radiocontrast injection in a patient receiving low-dose oral methotrexate -a case report-Balaji VaithialingamRadhakrishnan Muthuchellappan0Mouleeswaran Sundaram1 Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, IndiaBackground Methotrexate is an antimetabolite drug that blocks dihydrofolate reductase and impairs cellular DNA synthesis. Administration of intravenous iodinated radiocontrast agents can cause life-threatening toxicity in patients receiving methotrexate. Case A 60-year-old female patient with rheumatoid arthritis underwent a craniotomy and clipping of a distal anterior cerebral artery aneurysm. The patient had been on low-dose oral methotrexate for the previous 5 years, which was discontinued two days before surgery. The patient received the first intravenous contrast agent injection (iohexol) during diagnostic cerebral angiography one day prior to surgery (50 ml) and the second contrast dose on the first postoperative day (60 ml). The patient developed severe methotrexate toxicity, leading to fatal multiorgan failure and death following repeated contrast imaging with intravenous iohexol. Conclusions Even though low-dose oral methotrexate has minor adverse effects, life-threatening toxicity can be precipitated in the presence of iodinated contrast agents.http://ekja.org/upload/pdf/kja-22067.pdfanesthesiaiohexolleucovorinmethotrexaterheumatoid arthritistoxicity |
| spellingShingle | Balaji Vaithialingam Radhakrishnan Muthuchellappan Mouleeswaran Sundaram Fatal multiorgan dysfunction following repeated iodinated radiocontrast injection in a patient receiving low-dose oral methotrexate -a case report- Korean Journal of Anesthesiology anesthesia iohexol leucovorin methotrexate rheumatoid arthritis toxicity |
| title | Fatal multiorgan dysfunction following repeated iodinated radiocontrast injection in a patient receiving low-dose oral methotrexate -a case report- |
| title_full | Fatal multiorgan dysfunction following repeated iodinated radiocontrast injection in a patient receiving low-dose oral methotrexate -a case report- |
| title_fullStr | Fatal multiorgan dysfunction following repeated iodinated radiocontrast injection in a patient receiving low-dose oral methotrexate -a case report- |
| title_full_unstemmed | Fatal multiorgan dysfunction following repeated iodinated radiocontrast injection in a patient receiving low-dose oral methotrexate -a case report- |
| title_short | Fatal multiorgan dysfunction following repeated iodinated radiocontrast injection in a patient receiving low-dose oral methotrexate -a case report- |
| title_sort | fatal multiorgan dysfunction following repeated iodinated radiocontrast injection in a patient receiving low dose oral methotrexate a case report |
| topic | anesthesia iohexol leucovorin methotrexate rheumatoid arthritis toxicity |
| url | http://ekja.org/upload/pdf/kja-22067.pdf |
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