Methotrexate-induced toxidermia and pancytopenia in a patient with ectopic pregnancy: a case report
Abstract Background Methotrexate is an anticancer drug from the antimetabolite class. It is also used in gynecology and obstetrics and is the molecule of choice for the medical treatment of ectopic pregnancies. We report a case of toxidermia associated with severe pancytopenia induced by methotrexat...
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| Format: | Article |
| Language: | English |
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BMC
2021-12-01
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| Series: | Journal of Medical Case Reports |
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| Online Access: | https://doi.org/10.1186/s13256-021-03111-x |
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| author | Valéry Refeno Naharisoa Giannie Rasamimanana Baco Abdallah Abasse Malalafinaritra Patrick Marco Ramarokoto Mahefaniaina Jean Eustache Fanomezantsoa Pierana Gabriel Randaoharison |
| author_facet | Valéry Refeno Naharisoa Giannie Rasamimanana Baco Abdallah Abasse Malalafinaritra Patrick Marco Ramarokoto Mahefaniaina Jean Eustache Fanomezantsoa Pierana Gabriel Randaoharison |
| author_sort | Valéry Refeno |
| collection | DOAJ |
| description | Abstract Background Methotrexate is an anticancer drug from the antimetabolite class. It is also used in gynecology and obstetrics and is the molecule of choice for the medical treatment of ectopic pregnancies. We report a case of toxidermia associated with severe pancytopenia induced by methotrexate for ectopic pregnancy. Case presentation A 30-year-old Malagasy (African) woman was admitted to the Emergency and Intensive Care Department for probable toxidermia following injection of 75 mg of methotrexate for an ectopic pregnancy. She had developed generalized erythema, which started 48 hours after the injection. The secondary onset of phlyctenular maculopapular skin lesions, generalized purpura, and erosions of the oral mucosa in a context of febrile jaundice prompted her hospitalization. On admission, the patient presented with febrile neutropenia, pancytopenia, renal failure, and hepatic cytolysis. She received transfusions of fresh whole blood, erythromycin, and amphotericin B. The course was fatal within 2 days of hospitalization. The patient died of multiple organ failure. Conclusions Our case is mainly distinguished by the lack of use of granulocyte growth factors and folinic acid. In the event of severe reactions to methotrexate, the management should be multidisciplinary and as much as possible within an intensive care unit. |
| first_indexed | 2024-12-14T14:30:23Z |
| format | Article |
| id | doaj.art-f0f328b5cea44562bd3d81aa5e1effbf |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-12-14T14:30:23Z |
| publishDate | 2021-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-f0f328b5cea44562bd3d81aa5e1effbf2022-12-21T22:57:50ZengBMCJournal of Medical Case Reports1752-19472021-12-011511510.1186/s13256-021-03111-xMethotrexate-induced toxidermia and pancytopenia in a patient with ectopic pregnancy: a case reportValéry Refeno0Naharisoa Giannie Rasamimanana1Baco Abdallah Abasse2Malalafinaritra Patrick Marco Ramarokoto3Mahefaniaina Jean Eustache Fanomezantsoa4Pierana Gabriel Randaoharison5Medicine Faculty of Mahajanga, Oncology Department of Professor ZAFISAONA Gabriel Teaching HospitalMedicine Faculty of Mahajanga, Emergency and Intensive Care Department of Professor ZAFISAONA Gabriel Teaching HospitalMedicine Faculty of Antananarivo, Mother and Child Complex of Professor ZAFISAONA Gabriel Teaching HospitalMedicine Faculty of Mahajanga, Mother and Child Complex of Professor ZAFISAONA Gabriel Teaching HospitalMedicine Faculty of Mahajanga, Mother and Child Complex of Professor ZAFISAONA Gabriel Teaching HospitalMedicine Faculty of Mahajanga, Mother and Child Complex of Professor ZAFISAONA Gabriel Teaching HospitalAbstract Background Methotrexate is an anticancer drug from the antimetabolite class. It is also used in gynecology and obstetrics and is the molecule of choice for the medical treatment of ectopic pregnancies. We report a case of toxidermia associated with severe pancytopenia induced by methotrexate for ectopic pregnancy. Case presentation A 30-year-old Malagasy (African) woman was admitted to the Emergency and Intensive Care Department for probable toxidermia following injection of 75 mg of methotrexate for an ectopic pregnancy. She had developed generalized erythema, which started 48 hours after the injection. The secondary onset of phlyctenular maculopapular skin lesions, generalized purpura, and erosions of the oral mucosa in a context of febrile jaundice prompted her hospitalization. On admission, the patient presented with febrile neutropenia, pancytopenia, renal failure, and hepatic cytolysis. She received transfusions of fresh whole blood, erythromycin, and amphotericin B. The course was fatal within 2 days of hospitalization. The patient died of multiple organ failure. Conclusions Our case is mainly distinguished by the lack of use of granulocyte growth factors and folinic acid. In the event of severe reactions to methotrexate, the management should be multidisciplinary and as much as possible within an intensive care unit.https://doi.org/10.1186/s13256-021-03111-xMethotrexateEctopic pregnancyDrug eruptionPancytopeniaCase report |
| spellingShingle | Valéry Refeno Naharisoa Giannie Rasamimanana Baco Abdallah Abasse Malalafinaritra Patrick Marco Ramarokoto Mahefaniaina Jean Eustache Fanomezantsoa Pierana Gabriel Randaoharison Methotrexate-induced toxidermia and pancytopenia in a patient with ectopic pregnancy: a case report Journal of Medical Case Reports Methotrexate Ectopic pregnancy Drug eruption Pancytopenia Case report |
| title | Methotrexate-induced toxidermia and pancytopenia in a patient with ectopic pregnancy: a case report |
| title_full | Methotrexate-induced toxidermia and pancytopenia in a patient with ectopic pregnancy: a case report |
| title_fullStr | Methotrexate-induced toxidermia and pancytopenia in a patient with ectopic pregnancy: a case report |
| title_full_unstemmed | Methotrexate-induced toxidermia and pancytopenia in a patient with ectopic pregnancy: a case report |
| title_short | Methotrexate-induced toxidermia and pancytopenia in a patient with ectopic pregnancy: a case report |
| title_sort | methotrexate induced toxidermia and pancytopenia in a patient with ectopic pregnancy a case report |
| topic | Methotrexate Ectopic pregnancy Drug eruption Pancytopenia Case report |
| url | https://doi.org/10.1186/s13256-021-03111-x |
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